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["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)"},{"$f":"CodeLookup[[#Headers],[PCTC\n(26/TC)]]","v":"PCTC\n(26/TC)"}]
["Enter code --> ","e0621",{"$f":"IF(CodeLookup[Modifiers]=0,\" \",CodeLookup[Modifiers])","v":"NU"},{"$f":"CodeLookup[Short Description (HCPCS and Local Only)]","v":"Patient lift sling or seat"},{"$f":"CodeLookup[NON-FACILITY SETTING]","v":173.28},{"$f":"CodeLookup[FACILITY SETTING]","v":173.28},{"$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":9}]
["Is there a modifier?","Yes",{"$f":"CodeLookup[[#Headers],[MSI\n(-51)]]","v":"MSI\n(-51)"},{"$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":"Select the modifier"},"NU",{"$f":"CodeLookup[MSI\n(-51)]","v":9},{"$f":"CodeLookup[BSI\n(-50)]","v":9},{"$f":"CodeLookup[ASI\n(-80)]","v":9},{"$f":"CodeLookup[CSI\n(-62)]","v":9},{"$f":"CodeLookup[TSI\n(-66)]","v":9},{"$f":"CodeLookup[ENDO\nBASE]","v":0},{"$f":"CodeLookup[FSI]","v":"F"},{"$f":"CodeLookup[LIC REQ]","v":0},{"$f":"IF(CodeLookup[Prior Auth]=0,\"\",CodeLookup[Prior Auth])","v":""}]
[null,null,"NOTE: The MARFS chapters linked below are recommended for your understanding of these codes but are not to be considered explicit context and do not remove your responsibility to bill properly in accordance with the L&I Provider Agreement, applicable RCWs and WACs, and the MARFS in its entirety."]
[]
[null,null,{"$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 9: Durable Medical Equipment (DME)"}]
[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":""}]
[]
[]
[]
[]
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[{"$f":"CodeLookup[MARFS Chapters]","v":2},{"$f":"CodeLookup[MARFS Chapters2]","v":9},{"$f":"CodeLookup[MARFS Chapters3]","v":0}]
[{"$f":"IFERROR(VLOOKUP(A24,'MARFS_URL''s'!$B$2:$D$37,2,),\"\")","v":"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter2.pdf"},{"$f":"IFERROR(VLOOKUP(B24,'MARFS_URL''s'!$B$2:$D$37,2,),\"\")","v":"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter9.pdf"},{"$f":"IFERROR(VLOOKUP(C24,'MARFS_URL''s'!$B$2:$D$37,2,),\"\")","v":""},{"$f":"VLOOKUP(K5,'MARFS_URL''s'!$B$40:$D$43,2,)","v":{"$error":"#N/A"}}]
[{"$f":"IFERROR(VLOOKUP(A24,'MARFS_URL''s'!$B$2:$D$37,3,),\"\")","v":"Chapter 2: Information for All Providers"},{"$f":"IFERROR(VLOOKUP(B24,'MARFS_URL''s'!$B$2:$D$37,3,),\"\")","v":"Chapter 9: Durable Medical Equipment (DME)"},{"$f":"IFERROR(VLOOKUP(C24,'MARFS_URL''s'!$B$2:$D$37,3,),\"\")","v":""},{"$f":"VLOOKUP(K5,'MARFS_URL''s'!$B$40:$D$43,3,)","v":{"$error":"#N/A"}}]
[]
[]
[{"$f":"CodeLookup[[#Headers],[CODE]]","v":"CODE"}]
[{"$f":"CodeLookup[CODE]","v":"E0621"}]

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[]
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[]
["Professional Services Fee Schedule"]
[]
["CPT® Through Local Codes"]
[]
[]
[]
["Effective for Dates of Service on or After"]
[]
["2023-07-01"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
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["ANESTHESIA SERVICES FEE SCHEDULE                   "]
["FIELD KEY:  "]
["Column Title",null,"Column Description",null,null,"Column Values",null,"Value Definitions"]
["CPTÒ CODE",null,"2022 CPT® anesthesia code.",null,null,null,null,"2022 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,"2022 CPT® or HCPCS code",null,null,null,null,null,null,null,"2022 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"]
[null,null,null,null,null,null,null,null,"Y-ONC",null,"Prior authorization from ONC required"]
[null,null,null,null,null,null,null,null,"Y-CM",null,"Prior authorization from claim manager 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":"2023 Professional Fee Schedule","index":2,"n_rows":20265,"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"]
["01953",null,"See CPT",null,57.45,null,57.45,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["01996",null,"See CPT",null,76.153199999999998,null,76.153199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["01999",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[10004,null,"See CPT",null,92.287000000000006,null,75.615799999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10005,null,"See CPT",null,252.4496,null,131.58339999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10006,null,"See CPT",null,109.5536,null,89.31,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10007,null,"See CPT",null,560.86680000000001,null,157.78100000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10008,null,"See CPT",null,269.12079999999997,null,91.691599999999994,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10009,null,"See CPT",null,825.81979999999999,null,194.10039999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10010,null,"See CPT",null,450.12239999999997,null,126.2248,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,1236.0504000000001,null,239.9462,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,218.51179999999999,null,93.477800000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10060,null,"See CPT",null,234.58759999999998,null,194.69579999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10061,null,"See CPT",null,394.15480000000002,null,336.40100000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10080,null,"See CPT",null,478.70159999999993,null,192.3142,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10081,null,"See CPT",null,647.19979999999998,null,310.20339999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10120,null,"See CPT",null,284.00579999999997,null,194.10039999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10121,null,"See CPT",null,491.80039999999997,null,334.01940000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10140,null,"See CPT",null,315.56200000000001,null,215.53479999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10160,null,"See CPT",null,242.32780000000002,null,176.8338,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10180,null,"See CPT",null,490.01420000000002,null,325.08839999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11000,null,"See CPT",null,107.76739999999999,null,48.227400000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11001,null,"See CPT",null,50.608999999999995,null,26.197600000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11004,null,"See CPT",null,1000.8673999999999,null,1000.8673999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11005,null,"See CPT",null,1356.9166,null,1356.9166,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11006,null,"See CPT",null,1231.2872,null,1231.2872,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11008,null,"See CPT",null,478.10619999999994,null,478.10619999999994,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11010,null,"See CPT",null,843.68179999999995,null,498.94520000000006,null,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R"]
[11011,null,"See CPT",null,922.87,null,528.7152000000001,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[11012,null,"See CPT",null,1205.0895999999998,null,743.05920000000003,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[11042,null,"See CPT",null,241.73239999999998,null,107.76739999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11043,null,"See CPT",null,427.49719999999996,null,274.4794,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11044,null,"See CPT",null,567.4162,null,400.70420000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11045,null,"See CPT",null,73.234200000000001,null,44.655000000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11046,null,"See CPT",null,132.17880000000002,null,96.454800000000006,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11047,null,"See CPT",null,217.91640000000001,null,170.87980000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11055,null,"See CPT",null,135.75119999999998,null,27.983799999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11056,null,"See CPT",null,155.9948,null,39.296399999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11057,null,"See CPT",null,169.68899999999999,null,50.608999999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11102,null,"See CPT",null,191.71880000000002,null,67.875599999999991,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11103,null,"See CPT",null,94.668599999999998,null,38.701000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11104,null,"See CPT",null,237.56460000000001,null,84.54679999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11105,null,"See CPT",null,111.33980000000001,null,45.845799999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11106,null,"See CPT",null,294.12760000000003,null,101.21799999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11107,null,"See CPT",null,134.56039999999999,null,55.372199999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11200,null,"See CPT",null,170.87980000000002,null,141.70519999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11201,null,"See CPT",null,33.342400000000005,null,29.77,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[11300,null,"See CPT",null,192.3142,null,61.3262,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11301,null,"See CPT",null,230.41980000000001,null,92.287000000000006,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11302,null,"See CPT",null,258.99899999999997,null,107.76739999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11303,null,"See CPT",null,286.38739999999996,null,127.41560000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11305,null,"See CPT",null,200.05439999999999,null,66.68480000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11306,null,"See CPT",null,232.20599999999999,null,88.119199999999992,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11307,null,"See CPT",null,261.976,null,112.53059999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11308,null,"See CPT",null,275.07479999999998,null,125.03400000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11310,null,"See CPT",null,220.298,null,82.165199999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11311,null,"See CPT",null,257.8082,null,113.12599999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11312,null,"See CPT",null,294.12760000000003,null,135.1558,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11313,null,"See CPT",null,339.97339999999997,null,172.07060000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11400,null,"See CPT",null,241.73239999999998,null,155.39939999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11401,null,"See CPT",null,293.53219999999999,null,195.29119999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11402,null,"See CPT",null,322.1114,null,212.55779999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11403,null,"See CPT",null,369.14800000000002,null,273.88399999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11404,null,"See CPT",null,418.56619999999998,null,300.67699999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11406,null,"See CPT",null,588.85059999999999,null,450.12239999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11420,null,"See CPT",null,239.9462,null,151.23159999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11421,null,"See CPT",null,300.08159999999998,null,201.24519999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11422,null,"See CPT",null,335.80559999999997,null,249.47260000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11423,null,"See CPT",null,381.65140000000002,null,286.38739999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11424,null,"See CPT",null,438.21440000000001,null,326.2792,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11426,null,"See CPT",null,608.49880000000007,null,488.82340000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11440,null,"See CPT",null,270.90699999999998,null,197.6728,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11441,null,"See CPT",null,326.2792,null,245.3048,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11442,null,"See CPT",null,362.00319999999999,null,270.3116,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11443,null,"See CPT",null,425.11559999999997,null,327.46999999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11444,null,"See CPT",null,525.14279999999997,null,411.42140000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11446,null,"See CPT",null,705.54899999999998,null,573.96559999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11450,null,"See CPT",null,810.33939999999996,null,478.70159999999993,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[11451,null,"See CPT",null,987.17319999999984,null,604.92639999999994,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11462,null,"See CPT",null,785.33259999999996,null,454.29019999999997,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11463,null,"See CPT",null,1001.4628,null,609.0942,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11470,null,"See CPT",null,857.37599999999998,null,525.73820000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[11471,null,"See CPT",null,1011.5845999999999,null,637.67340000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[11600,null,"See CPT",null,370.93420000000003,null,223.27500000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11601,null,"See CPT",null,428.0926,null,270.90699999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11602,null,"See CPT",null,457.86260000000004,null,294.12760000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11603,null,"See CPT",null,520.37959999999998,null,351.286,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11604,null,"See CPT",null,578.72879999999998,null,385.81920000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11606,null,"See CPT",null,826.41520000000003,null,568.60700000000008,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11620,null,"See CPT",null,372.72039999999998,null,224.4658,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11621,null,"See CPT",null,430.4742,null,272.09780000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11622,null,"See CPT",null,472.74760000000003,null,308.41719999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11623,null,"See CPT",null,550.745,null,380.4606,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11624,null,"See CPT",null,625.7654,null,430.4742,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11626,null,"See CPT",null,751.39479999999992,null,525.14279999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11640,null,"See CPT",null,381.65140000000002,null,231.61060000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11641,null,"See CPT",null,444.16840000000002,null,283.41039999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11642,null,"See CPT",null,500.13600000000002,null,330.447,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11643,null,"See CPT",null,585.27819999999997,null,411.42140000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11644,null,"See CPT",null,719.83859999999993,null,509.06700000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11646,null,"See CPT",null,930.01479999999992,null,701.38119999999992,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11719,null,"See CPT",null,26.197600000000001,null,13.098800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11720,null,"See CPT",null,60.730800000000002,null,25.6022,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11721,null,"See CPT",null,82.165199999999999,null,42.273399999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11730,null,"See CPT",null,215.53479999999999,null,96.454800000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11732,null,"See CPT",null,61.921599999999998,null,30.365400000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11740,null,"See CPT",null,107.76739999999999,null,58.944600000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11750,null,"See CPT",null,297.7,null,183.9786,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11755,null,"See CPT",null,229.22900000000001,null,108.36280000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11760,null,"See CPT",null,350.69059999999996,null,201.84059999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11762,null,"See CPT",null,536.45539999999994,null,339.97339999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11765,null,"See CPT",null,311.39420000000001,null,169.68899999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11770,null,"See CPT",null,667.4434,null,335.80559999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11771,null,"See CPT",null,1168.1748,null,817.48419999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11772,null,"See CPT",null,1437.2955999999999,null,1059.2166,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11900,null,"See CPT",null,106.5766,null,54.181400000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11901,null,"See CPT",null,129.7972,null,82.165199999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11920,null,"See CPT",null,359.6216,null,197.07740000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11921,null,"See CPT",null,417.37539999999996,null,236.9692,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11922,null,"See CPT",null,113.72139999999999,null,52.395200000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[11950,null,"See CPT",null,151.23159999999999,null,94.0732,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11951,null,"See CPT",null,199.459,null,130.988,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11952,null,"See CPT",null,266.1438,null,183.38319999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11954,null,"See CPT",null,292.93680000000001,null,200.6498,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11960,null,"See CPT",null,1870.1514,null,1870.1514,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[11970,null,"See CPT",null,1027.6604,null,1027.6604,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[11971,null,"See CPT",null,1011.5845999999999,null,1011.5845999999999,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,185.1694,null,111.33980000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11982,null,"See CPT",null,206.60380000000001,null,131.58339999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11983,null,"See CPT",null,260.18979999999999,null,184.57400000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[12001,null,"See CPT",null,175.643,null,79.783600000000007,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12002,null,"See CPT",null,211.36699999999999,null,104.19499999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12004,null,"See CPT",null,244.70940000000002,null,129.20179999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12005,null,"See CPT",null,326.87459999999999,null,166.11660000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12006,null,"See CPT",null,378.67439999999999,null,204.8176,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12007,null,"See CPT",null,425.11559999999997,null,254.83120000000002,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[12011,null,"See CPT",null,209.58080000000001,null,97.645599999999988,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12013,null,"See CPT",null,217.91640000000001,null,102.4088,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12014,null,"See CPT",null,264.95300000000003,null,130.988,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12015,null,"See CPT",null,317.9436,null,165.52119999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12016,null,"See CPT",null,404.27659999999997,null,224.4658,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12017,null,"See CPT",null,269.71620000000001,null,269.71620000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[12018,null,"See CPT",null,304.24940000000004,null,304.24940000000004,null,"000",0,0,0,0,2,0,2,0,0,null,"R"]
[12020,null,"See CPT",null,561.46219999999994,null,342.9504,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12021,null,"See CPT",null,328.66079999999999,null,257.8082,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12031,null,"See CPT",null,497.15899999999999,null,277.45640000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12032,null,"See CPT",null,570.98860000000002,null,347.1182,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12034,null,"See CPT",null,626.36079999999993,null,373.31579999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12035,null,"See CPT",null,726.98340000000007,null,436.4282,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12036,null,"See CPT",null,802.5992,null,506.68539999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12037,null,"See CPT",null,896.67240000000004,null,588.25520000000006,null,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R"]
[12041,null,"See CPT",null,498.34979999999996,null,264.35760000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12042,null,"See CPT",null,581.11040000000003,null,356.04920000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12044,null,"See CPT",null,716.86159999999995,null,387.60539999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12045,null,"See CPT",null,774.61540000000002,null,499.54060000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12046,null,"See CPT",null,929.4194,null,573.37020000000007,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[12047,null,"See CPT",null,1016.3478,null,635.88720000000001,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[12051,null,"See CPT",null,534.07380000000001,null,309.01260000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12052,null,"See CPT",null,592.423,null,363.19399999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12053,null,"See CPT",null,684.1146,null,391.17779999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12054,null,"See CPT",null,721.02940000000001,null,396.53640000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12055,null,"See CPT",null,949.6629999999999,null,541.81399999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12056,null,"See CPT",null,1083.6279999999999,null,698.99959999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[12057,null,"See CPT",null,1135.4277999999999,null,760.32579999999996,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[13100,null,"See CPT",null,640.65039999999999,null,363.7894,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13101,null,"See CPT",null,746.03620000000001,null,450.12239999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13102,null,"See CPT",null,216.72560000000001,null,128.011,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13120,null,"See CPT",null,667.4434,null,422.73399999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13121,null,"See CPT",null,797.24059999999997,null,466.19819999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13122,null,"See CPT",null,235.7784,null,147.6592,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13131,null,"See CPT",null,726.98340000000007,null,437.61899999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13132,null,"See CPT",null,880.59659999999997,null,547.76799999999992,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13133,null,"See CPT",null,309.608,null,223.87039999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13151,null,"See CPT",null,790.69119999999998,null,503.11299999999994,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13152,null,"See CPT",null,926.44240000000002,null,606.11720000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13153,null,"See CPT",null,341.16419999999999,null,244.70940000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13160,null,"See CPT",null,1442.0588,null,1442.0588,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14000,null,"See CPT",null,1179.4874,null,920.48840000000007,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14001,null,"See CPT",null,1497.4309999999998,null,1187.8229999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14020,null,"See CPT",null,1305.1168,null,1035.9959999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14021,null,"See CPT",null,1602.8168000000001,null,1291.4226000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14040,null,"See CPT",null,1406.3348000000001,null,1137.2140000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14041,null,"See CPT",null,1705.2256,null,1387.8773999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14060,null,"See CPT",null,1418.8381999999999,null,1213.4251999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14061,null,"See CPT",null,1839.1905999999999,null,1490.2862,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14301,null,"See CPT",null,1999.9486000000002,null,1576.0237999999999,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[14302,null,"See CPT",null,384.6284,null,384.6284,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[14350,null,"See CPT",null,1227.7148,null,1227.7148,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15002,null,"See CPT",null,638.86419999999998,null,391.77319999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15003,null,"See CPT",null,127.41560000000001,null,79.783600000000007,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15004,null,"See CPT",null,728.76959999999997,null,466.19819999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15005,null,"See CPT",null,211.36699999999999,null,158.37640000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15040,null,"See CPT",null,493.58659999999992,null,222.08420000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15050,null,"See CPT",null,1105.0623999999998,null,848.44499999999994,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15100,null,"See CPT",null,1601.626,null,1300.9490000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15101,null,"See CPT",null,345.92739999999998,null,198.26820000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15110,null,"See CPT",null,1524.2240000000002,null,1289.0409999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15111,null,"See CPT",null,201.24519999999998,null,180.40619999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15115,null,"See CPT",null,1466.4702,null,1244.9813999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15116,null,"See CPT",null,276.86099999999999,null,246.49559999999997,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15120,null,"See CPT",null,1558.1618000000001,null,1252.1262000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15121,null,"See CPT",null,387.60539999999997,null,239.9462,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15130,null,"See CPT",null,1338.4592,null,1092.559,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15131,null,"See CPT",null,175.643,null,160.1626,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15135,null,"See CPT",null,1619.4879999999998,null,1382.5187999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15136,null,"See CPT",null,173.26140000000001,null,160.1626,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15150,null,"See CPT",null,1281.8962000000001,null,1150.3127999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15151,null,"See CPT",null,210.17619999999999,null,191.71880000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15152,null,"See CPT",null,268.52539999999999,null,250.06800000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15155,null,"See CPT",null,1460.5162,null,1327.742,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15156,null,"See CPT",null,281.62420000000003,null,263.16679999999997,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15157,null,"See CPT",null,314.37119999999999,null,286.9828,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15200,null,"See CPT",null,1548.6354000000001,null,1222.9515999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15201,null,"See CPT",null,261.976,null,136.3466,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15220,null,"See CPT",null,1427.1737999999998,null,1113.3979999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15221,null,"See CPT",null,242.32780000000002,null,122.6524,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15240,null,"See CPT",null,1718.9198000000001,null,1453.3714,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15241,null,"See CPT",null,320.92059999999998,null,188.1464,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15260,null,"See CPT",null,1846.9307999999999,null,1543.2768000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15261,null,"See CPT",null,381.05600000000004,null,244.11399999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15271,null,"See CPT",null,285.79199999999997,null,148.85,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15272,null,"See CPT",null,44.059599999999996,null,29.77,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15273,null,"See CPT",null,573.37020000000007,null,347.1182,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15274,null,"See CPT",null,153.01779999999999,null,79.188200000000009,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15275,null,"See CPT",null,294.12760000000003,null,166.11660000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15276,null,"See CPT",null,58.944600000000001,null,44.059599999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15277,null,"See CPT",null,635.88720000000001,null,398.91800000000001,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[15278,null,"See CPT",null,176.23839999999998,null,98.836399999999998,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15570,null,"See CPT",null,1675.4556,null,1327.1466,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15572,null,"See CPT",null,1625.442,null,1342.0316,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15574,null,"See CPT",null,1616.511,null,1337.8637999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15576,null,"See CPT",null,1445.0357999999999,null,1183.0598,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15600,null,"See CPT",null,639.45960000000002,null,392.964,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15610,null,"See CPT",null,693.64099999999996,null,452.50399999999996,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15620,null,"See CPT",null,838.91859999999997,null,602.5447999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15630,null,"See CPT",null,865.11619999999994,null,632.91020000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15650,null,"See CPT",null,1010.3937999999999,null,741.27299999999991,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15730,null,"See CPT",null,2665.0103999999997,null,1667.12,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15731,null,"See CPT",null,2066.6334000000002,null,1817.7562,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15733,null,"See CPT",null,1868.3652,null,1868.3652,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15734,null,"See CPT",null,2700.7343999999998,null,2700.7343999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15736,null,"See CPT",null,2208.3386,null,2208.3386,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15738,null,"See CPT",null,2294.6716000000001,null,2294.6716000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15740,null,"See CPT",null,1866.579,null,1533.155,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15750,null,"See CPT",null,1681.4096,null,1681.4096,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[15756,null,"See CPT",null,4127.3127999999997,null,4127.3127999999997,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15757,null,"See CPT",null,4105.2830000000004,null,4105.2830000000004,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15758,null,"See CPT",null,4091.5888,null,4091.5888,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15760,null,"See CPT",null,1565.902,null,1277.7284,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15769,null,"See CPT",null,875.83339999999998,null,875.83339999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[15770,null,"See CPT",null,1231.8826000000001,null,1231.8826000000001,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,698.99959999999999,null,459.05340000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15776,null,"See CPT",null,942.51819999999998,null,626.95619999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15777,null,"See CPT",null,382.84219999999999,null,382.84219999999999,null,"000",0,0,0,0,0,1,1,0,0,null,"R"]
[15778,null,"See CPT",null,679.94679999999994,null,679.94679999999994,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[15780,null,"See CPT",null,1576.0237999999999,null,1215.8068000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15781,null,"See CPT",null,1006.2259999999999,null,789.50040000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15782,null,"See CPT",null,907.98500000000001,null,679.94679999999994,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15783,null,"See CPT",null,838.32320000000004,null,651.96299999999997,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15786,null,"See CPT",null,431.06959999999998,null,244.70940000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[15787,null,"See CPT",null,55.967599999999997,null,29.77,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,1074.1016,null,949.06759999999997,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15821,null,"See CPT",null,1148.5265999999999,null,1010.9892,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15822,null,"See CPT",null,860.35299999999995,null,736.50979999999993,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[15823,null,"See CPT",null,1152.0990000000002,null,1013.3707999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[15824,null,"See CPT",null,1608.0177083667843,null,1608.0177083667843,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15825,null,"See CPT",null,1382.618072268576,null,1382.618072268576,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15826,null,"See CPT",null,1307.4701491463043,null,1307.4701491463043,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15828,null,"See CPT",null,4478.4344653139533,null,4478.4344653139533,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,2124.3872000000001,null,2124.3872000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[15832,null,"See CPT",null,1679.6233999999999,null,1679.6233999999999,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[15833,null,"See CPT",null,1602.2213999999999,null,1602.2213999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15834,null,"See CPT",null,1630.2051999999999,null,1630.2051999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15835,null,"See CPT",null,1696.8899999999999,null,1696.8899999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15836,null,"See CPT",null,1458.1345999999999,null,1458.1345999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15837,null,"See CPT",null,1604.0076000000001,null,1311.0708,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15838,null,"See CPT",null,1191.3954000000001,null,1191.3954000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15839,null,"See CPT",null,1643.8994,null,1347.3901999999998,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15840,null,"See CPT",null,1845.74,null,1845.74,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15841,null,"See CPT",null,3227.6633999999999,null,3227.6633999999999,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15842,null,"See CPT",null,4875.1351999999997,null,4875.1351999999997,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15845,null,"See CPT",null,1936.8362,null,1936.8362,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"]
[15851,null,"See CPT",null,102.4088,null,117.29379999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15852,null,"See CPT",null,81.569800000000001,null,81.569800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15853,null,"See CPT",null,21.4344,null,21.4344,null,"000",0,0,0,5,2,0,1,0,0,null,"R"]
[15854,null,"See CPT",null,30.365400000000001,null,30.365400000000001,null,"000",0,0,0,5,2,0,1,0,0,null,"R"]
[15860,null,"See CPT",null,188.74179999999998,null,188.74179999999998,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,1171.1518000000001,null,1171.1518000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15922,null,"See CPT",null,1462.3023999999998,null,1462.3023999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15931,null,"See CPT",null,1278.9192,null,1278.9192,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15933,null,"See CPT",null,1586.1456000000001,null,1586.1456000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15934,null,"See CPT",null,1721.8968,null,1721.8968,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15935,null,"See CPT",null,2110.6930000000002,null,2110.6930000000002,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15936,null,"See CPT",null,1634.9684,null,1634.9684,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15937,null,"See CPT",null,1896.3490000000002,null,1896.3490000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15940,null,"See CPT",null,1287.2547999999999,null,1287.2547999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15941,null,"See CPT",null,1711.7749999999999,null,1711.7749999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15944,null,"See CPT",null,1711.1795999999999,null,1711.1795999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15945,null,"See CPT",null,1865.3881999999999,null,1865.3881999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15946,null,"See CPT",null,2929.3679999999999,null,2929.3679999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15950,null,"See CPT",null,1169.9609999999998,null,1169.9609999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15951,null,"See CPT",null,1649.258,null,1649.258,null,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R"]
[15952,null,"See CPT",null,1676.0509999999999,null,1676.0509999999999,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15953,null,"See CPT",null,1846.3354000000002,null,1846.3354000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15956,null,"See CPT",null,2113.67,null,2113.67,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15958,null,"See CPT",null,2146.4169999999999,null,2146.4169999999999,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,144.68219999999999,null,81.569800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16020,null,"See CPT",null,159.56720000000001,null,101.21799999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16025,null,"See CPT",null,288.76899999999995,null,198.86359999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16030,null,"See CPT",null,363.19399999999996,null,235.7784,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16035,null,"See CPT",null,345.92739999999998,null,345.92739999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16036,null,"See CPT",null,145.87300000000002,null,145.87300000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[17000,null,"See CPT",null,125.62939999999999,null,101.21799999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17003,null,"See CPT",null,12.503399999999999,null,3.5724,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17004,null,"See CPT",null,317.34820000000002,null,181.0016,null,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17106,null,"See CPT",null,638.26880000000006,null,505.49459999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17107,null,"See CPT",null,827.60599999999999,null,655.53539999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17108,null,"See CPT",null,1167.5793999999999,null,957.40319999999986,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[17110,null,"See CPT",null,214.93939999999998,null,124.43859999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17111,null,"See CPT",null,250.06800000000001,null,151.827,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17250,null,"See CPT",null,165.52119999999999,null,67.875599999999991,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[17260,null,"See CPT",null,186.9556,null,129.20179999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17261,null,"See CPT",null,278.05180000000001,null,158.37640000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17262,null,"See CPT",null,334.6148,null,201.24519999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17263,null,"See CPT",null,361.40780000000001,null,222.08420000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17264,null,"See CPT",null,387.01,null,236.37380000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17266,null,"See CPT",null,440.00059999999996,null,278.6472,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17270,null,"See CPT",null,280.43340000000001,null,173.85679999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17271,null,"See CPT",null,311.9896,null,191.71880000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17272,null,"See CPT",null,353.07219999999995,null,220.298,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17273,null,"See CPT",null,390.58239999999995,null,248.87719999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17274,null,"See CPT",null,456.07639999999998,null,304.24940000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17276,null,"See CPT",null,528.11979999999994,null,365.57559999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17280,null,"See CPT",null,262.57139999999998,null,157.78100000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17281,null,"See CPT",null,336.40100000000001,null,214.93939999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17282,null,"See CPT",null,384.03300000000002,null,248.2818,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17283,null,"See CPT",null,451.90859999999998,null,308.41719999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17284,null,"See CPT",null,513.23479999999995,null,359.6216,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17286,null,"See CPT",null,653.74919999999997,null,484.65560000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17311,null,"See CPT",null,1268.7973999999999,null,639.45960000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17312,null,"See CPT",null,773.42460000000005,null,340.56879999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17313,null,"See CPT",null,1193.1815999999999,null,572.77479999999991,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17314,null,"See CPT",null,741.86840000000007,null,314.96659999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17315,null,"See CPT",null,146.4684,null,90.500799999999998,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,191.1234,null,75.615799999999993,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[19001,null,"See CPT",null,47.632000000000005,null,36.9148,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[19020,null,"See CPT",null,879.4058,null,574.56100000000004,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[19030,null,"See CPT",null,309.608,null,136.3466,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19081,null,"See CPT",null,955.02159999999992,null,290.55520000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19082,null,"See CPT",null,746.03620000000001,null,146.4684,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19083,null,"See CPT",null,956.21239999999989,null,273.28859999999997,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19084,null,"See CPT",null,735.31899999999996,null,138.13279999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19085,null,"See CPT",null,1476.5920000000001,null,318.53899999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19086,null,"See CPT",null,1153.8851999999999,null,160.1626,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19100,null,"See CPT",null,281.02879999999999,null,121.4616,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19101,null,"See CPT",null,611.47579999999994,null,404.87199999999996,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,906.19880000000001,null,643.62739999999997,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19112,null,"See CPT",null,860.35299999999995,null,590.63679999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19120,null,"See CPT",null,953.83079999999995,null,756.75340000000006,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19125,null,"See CPT",null,1049.0948000000001,null,835.94159999999999,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[19126,null,"See CPT",null,281.02879999999999,null,281.02879999999999,null,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM"]
[19281,null,"See CPT",null,454.29019999999997,null,175.643,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19282,null,"See CPT",null,325.68379999999996,null,88.714600000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19283,null,"See CPT",null,491.80039999999997,null,176.8338,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19284,null,"See CPT",null,364.98019999999997,null,88.714600000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19285,null,"See CPT",null,710.31219999999996,null,150.63619999999997,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19286,null,"See CPT",null,586.46899999999994,null,75.615799999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19287,null,"See CPT",null,1228.3101999999999,null,223.87039999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19288,null,"See CPT",null,955.02159999999992,null,112.53059999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19294,null,"See CPT",null,288.17359999999996,null,288.17359999999996,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,1442.6541999999999,null,1442.6541999999999,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19318,null,"See CPT",null,1985.6590000000001,null,1985.6590000000001,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19325,null,"See CPT",null,1126.4968000000001,null,1126.4968000000001,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19328,null,"See CPT",null,1013.9662000000001,null,1013.9662000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19330,null,"See CPT",null,1180.0827999999999,null,1180.0827999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19340,null,"See CPT",null,1386.0912000000001,null,1386.0912000000001,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[19342,null,"See CPT",null,1390.259,null,1390.259,null,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM"]
[19350,null,"See CPT",null,1537.3227999999999,null,1231.2872,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,2122.6009999999997,null,2122.6009999999997,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19361,null,"See CPT",null,2822.1959999999999,null,2822.1959999999999,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19364,null,"See CPT",null,4907.2867999999999,null,4907.2867999999999,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19367,null,"See CPT",null,3205.6336000000001,null,3205.6336000000001,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19368,null,"See CPT",null,3917.732,null,3917.732,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19369,null,"See CPT",null,3641.4663999999998,null,3641.4663999999998,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19370,null,"See CPT",null,1226.5240000000001,null,1226.5240000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19371,null,"See CPT",null,1300.3535999999999,null,1300.3535999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19380,null,"See CPT",null,1474.2104000000002,null,1474.2104000000002,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19396,null,"See CPT",null,514.42560000000003,null,257.21280000000002,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,1069.3384000000001,null,1069.3384000000001,null,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[20101,null,"See CPT",null,1099.7038,null,375.69739999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20102,null,"See CPT",null,1144.9541999999999,null,455.48099999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20103,null,"See CPT",null,1050.2855999999999,null,623.38380000000006,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[20150,null,"See CPT",null,1820.1378,null,1820.1378,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[20200,null,"See CPT",null,409.6352,null,169.68899999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20205,null,"See CPT",null,567.4162,null,275.67019999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20206,null,"See CPT",null,426.90179999999998,null,103.0042,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20220,null,"See CPT",null,445.95460000000003,null,156.59019999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20225,null,"See CPT",null,731.1511999999999,null,230.41980000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20240,null,"See CPT",null,250.6634,null,250.6634,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20245,null,"See CPT",null,615.64359999999999,null,615.64359999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20250,null,"See CPT",null,704.95359999999994,null,704.95359999999994,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20251,null,"See CPT",null,763.30280000000005,null,763.30280000000005,null,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[20500,null,"See CPT",null,231.01519999999999,null,162.54419999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20501,null,"See CPT",null,273.88399999999996,null,64.898600000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20520,null,"See CPT",null,406.06280000000004,null,270.3116,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20525,null,"See CPT",null,874.04719999999998,null,449.52699999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20526,null,"See CPT",null,151.23159999999999,null,102.4088,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20527,null,"See CPT",null,161.35339999999999,null,118.4846,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20550,null,"See CPT",null,106.5766,null,69.661799999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20551,null,"See CPT",null,106.5766,null,69.661799999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20552,null,"See CPT",null,97.645599999999988,null,66.68480000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[20553,null,"See CPT",null,112.53059999999999,null,76.211200000000005,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,48.227400000000003,null,26.792999999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20561,null,"See CPT",null,69.661799999999999,null,39.891800000000003,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20600,null,"See CPT",null,97.645599999999988,null,63.707800000000006,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20604,null,"See CPT",null,152.42240000000001,null,82.165199999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20605,null,"See CPT",null,101.8134,null,66.089400000000012,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20606,null,"See CPT",null,165.52119999999999,null,92.882400000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20610,null,"See CPT",null,118.4846,null,80.974400000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20611,null,"See CPT",null,184.57400000000001,null,107.172,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20612,null,"See CPT",null,118.4846,null,73.829599999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20615,null,"See CPT",null,473.34300000000002,null,295.3184,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20650,null,"See CPT",null,421.54320000000001,null,299.4862,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R"]
[20660,null,"See CPT",null,425.71100000000001,null,425.71100000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20661,null,"See CPT",null,952.04459999999995,null,952.04459999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20662,null,"See CPT",null,962.16639999999995,null,962.16639999999995,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20663,null,"See CPT",null,887.7414,null,887.7414,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[20664,null,"See CPT",null,1612.3431999999998,null,1612.3431999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20665,null,"See CPT",null,218.51179999999999,null,179.8108,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[20670,null,"See CPT",null,678.75599999999997,null,266.1438,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20680,null,"See CPT",null,1118.7565999999999,null,765.08899999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20690,null,"See CPT",null,1085.4141999999999,null,1085.4141999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20692,null,"See CPT",null,2046.3897999999999,null,2046.3897999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20693,null,"See CPT",null,813.31640000000004,null,813.31640000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20694,null,"See CPT",null,803.19460000000004,null,629.33780000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20696,null,"See CPT",null,2128.5549999999998,null,2128.5549999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20697,null,"See CPT",null,3523.5771999999997,null,3523.5771999999997,null,"000",0,0,0,3,0,0,2,1,0,null,"R"]
[20700,null,"See CPT",null,150.63619999999997,null,150.63619999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20701,null,"See CPT",null,114.9122,null,114.9122,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20702,null,"See CPT",null,253.04499999999999,null,253.04499999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20703,null,"See CPT",null,182.78779999999998,null,182.78779999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20704,null,"See CPT",null,261.38059999999996,null,261.38059999999996,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20705,null,"See CPT",null,221.4888,null,221.4888,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20802,null,"See CPT",null,4931.1027999999997,null,4931.1027999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20805,null,"See CPT",null,5850.4004000000004,null,5850.4004000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20808,null,"See CPT",null,7047.7498000000005,null,7047.7498000000005,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20816,null,"See CPT",null,3692.6708000000003,null,3692.6708000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20822,null,"See CPT",null,3197.8933999999999,null,3197.8933999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20824,null,"See CPT",null,3699.8155999999999,null,3699.8155999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20827,null,"See CPT",null,3284.2263999999996,null,3284.2263999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20838,null,"See CPT",null,5009.6956,null,5009.6956,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20900,null,"See CPT",null,733.53279999999995,null,326.2792,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[20902,null,"See CPT",null,494.18200000000002,null,494.18200000000002,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[20910,null,"See CPT",null,880.59659999999997,null,880.59659999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20912,null,"See CPT",null,887.14599999999996,null,887.14599999999996,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20920,null,"See CPT",null,737.10520000000008,null,737.10520000000008,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[20922,null,"See CPT",null,1119.9474,null,896.67240000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20924,null,"See CPT",null,927.63319999999999,null,927.63319999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20930,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[20931,null,"See CPT",null,194.10039999999998,null,194.10039999999998,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[20932,null,"See CPT",null,1340.2454,null,1340.2454,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20933,null,"See CPT",null,1230.6918000000001,null,1230.6918000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20934,null,"See CPT",null,1339.65,null,1339.65,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20936,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[20937,null,"See CPT",null,294.72300000000001,null,294.72300000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[20938,null,"See CPT",null,321.51600000000002,null,321.51600000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[20939,null,"See CPT",null,123.8432,null,123.8432,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR"]
[20950,null,"See CPT",null,500.13600000000002,null,158.9718,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[20955,null,"See CPT",null,4446.4472000000005,null,4446.4472000000005,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20956,null,"See CPT",null,4742.3609999999999,null,4742.3609999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20957,null,"See CPT",null,4941.82,null,4941.82,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20962,null,"See CPT",null,4814.4044000000004,null,4814.4044000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20969,null,"See CPT",null,4903.1189999999997,null,4903.1189999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20970,null,"See CPT",null,5112.6998000000003,null,5112.6998000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20972,null,"See CPT",null,5097.8148000000001,null,5097.8148000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[20973,null,"See CPT",null,5381.2251999999999,null,5381.2251999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20974,null,"See CPT",null,153.61320000000001,null,92.287000000000006,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR"]
[20975,null,"See CPT",null,313.77579999999995,null,313.77579999999995,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20979,null,"See CPT",null,104.19499999999999,null,57.753799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR"]
[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,257.21280000000002,null,257.21280000000002,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,1362.2751999999998,null,1362.2751999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[21011,null,"See CPT",null,701.38119999999992,null,481.08319999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21012,null,"See CPT",null,621.59759999999994,null,621.59759999999994,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21013,null,"See CPT",null,999.67659999999989,null,738.29600000000005,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21014,null,"See CPT",null,956.21239999999989,null,956.21239999999989,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21015,null,"See CPT",null,1276.5376000000001,null,1276.5376000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[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,1459.3254000000002,null,1206.8758,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21026,null,"See CPT",null,993.72260000000006,null,786.52340000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21029,null,"See CPT",null,1428.3645999999999,null,1141.9772,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[21030,null,"See CPT",null,856.18520000000001,null,663.87099999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[21031,null,"See CPT",null,718.64779999999996,null,503.11299999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[21032,null,"See CPT",null,694.2364,null,479.29700000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[21034,null,"See CPT",null,2387.5540000000001,null,2052.3438000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21040,null,"See CPT",null,868.09320000000002,null,669.2296,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[21044,null,"See CPT",null,1576.6192000000001,null,1576.6192000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21045,null,"See CPT",null,2188.6904,null,2188.6904,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21046,null,"See CPT",null,1815.3745999999999,null,1815.3745999999999,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[21047,null,"See CPT",null,2209.5293999999999,null,2209.5293999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21048,null,"See CPT",null,1824.9009999999998,null,1824.9009999999998,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[21049,null,"See CPT",null,2089.2586000000001,null,2089.2586000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21050,null,"See CPT",null,1593.2904000000001,null,1593.2904000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[21060,null,"See CPT",null,1442.6541999999999,null,1442.6541999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21070,null,"See CPT",null,1123.5198,null,1123.5198,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[21073,null,"See CPT",null,703.16740000000004,null,443.57299999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[21076,null,"See CPT",null,1573.6422,null,1271.7744,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[21077,null,"See CPT",null,3854.0242000000003,null,3127.0408000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21079,null,"See CPT",null,2641.7898,null,2102.9528,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21080,null,"See CPT",null,3041.8986,null,2389.3402000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21081,null,"See CPT",null,2806.7156,null,2187.4996000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21082,null,"See CPT",null,2592.3715999999999,null,2000.5440000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21083,null,"See CPT",null,2479.2456000000002,null,1858.2434000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21084,null,"See CPT",null,2826.9591999999998,null,2147.6077999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21085,null,"See CPT",null,1242.5998,null,871.66560000000004,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[21086,null,"See CPT",null,2868.0418,null,2305.9841999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21087,null,"See CPT",null,2868.0418,null,2305.9841999999999,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,1167.5793999999999,null,653.15380000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21110,null,"See CPT",null,1633.1822,null,1348.5809999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21116,null,"See CPT",null,413.803,null,80.974400000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[21120,null,"See CPT",null,1246.1722,null,944.30439999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[21121,null,"See CPT",null,1171.7472,null,972.28819999999985,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21122,null,"See CPT",null,1381.9234000000001,null,1381.9234000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21123,null,"See CPT",null,1564.1158,null,1564.1158,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21125,null,"See CPT",null,5008.5048000000006,null,1215.8068000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21127,null,"See CPT",null,7678.8737999999994,null,1393.8314,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21137,null,"See CPT",null,1373.5878,null,1373.5878,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21138,null,"See CPT",null,1667.7154,null,1667.7154,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21139,null,"See CPT",null,1991.0175999999999,null,1991.0175999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21141,null,"See CPT",null,2442.9261999999999,null,2442.9261999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21142,null,"See CPT",null,2506.0386000000003,null,2506.0386000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21143,null,"See CPT",null,2581.0590000000002,null,2581.0590000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21145,null,"See CPT",null,2832.3177999999998,null,2832.3177999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21146,null,"See CPT",null,2957.3517999999999,null,2957.3517999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21147,null,"See CPT",null,3112.1558,null,3112.1558,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21150,null,"See CPT",null,2992.4803999999999,null,2992.4803999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21151,null,"See CPT",null,3290.1803999999997,null,3290.1803999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21154,null,"See CPT",null,3539.6530000000002,null,3539.6530000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21155,null,"See CPT",null,3921.3044,null,3921.3044,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21159,null,"See CPT",null,4691.7519999999995,null,4691.7519999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21160,null,"See CPT",null,5084.7160000000003,null,5084.7160000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21172,null,"See CPT",null,3794.4841999999999,null,3794.4841999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21175,null,"See CPT",null,4000.4925999999996,null,4000.4925999999996,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21179,null,"See CPT",null,2756.7019999999998,null,2756.7019999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21180,null,"See CPT",null,3076.4317999999998,null,3076.4317999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21181,null,"See CPT",null,1354.5350000000001,null,1354.5350000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[21182,null,"See CPT",null,3821.8725999999997,null,3821.8725999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21183,null,"See CPT",null,4155.8919999999998,null,4155.8919999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21184,null,"See CPT",null,4466.6907999999994,null,4466.6907999999994,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21188,null,"See CPT",null,2898.4072000000001,null,2898.4072000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21193,null,"See CPT",null,2251.8027999999999,null,2251.8027999999999,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[21194,null,"See CPT",null,2604.2796000000003,null,2604.2796000000003,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-UR"]
[21195,null,"See CPT",null,2462.5744,null,2462.5744,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-UR"]
[21196,null,"See CPT",null,2628.0956000000001,null,2628.0956000000001,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[21198,null,"See CPT",null,1867.1743999999999,null,1867.1743999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21199,null,"See CPT",null,1851.694,null,1851.694,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21206,null,"See CPT",null,1772.5057999999999,null,1772.5057999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21208,null,"See CPT",null,3106.2018000000003,null,1343.8178,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21209,null,"See CPT",null,1534.3458000000001,null,1147.3358000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21210,null,"See CPT",null,3339.0031999999997,null,1382.5187999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21215,null,"See CPT",null,7847.3720000000003,null,1434.3186000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21230,null,"See CPT",null,1365.8476000000001,null,1365.8476000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21235,null,"See CPT",null,1370.6107999999999,null,1047.904,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21240,null,"See CPT",null,1924.9281999999998,null,1924.9281999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21242,null,"See CPT",null,1857.6479999999999,null,1857.6479999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21243,null,"See CPT",null,3072.2640000000001,null,3072.2640000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21244,null,"See CPT",null,1854.0755999999999,null,1854.0755999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21245,null,"See CPT",null,2289.9083999999998,null,1744.5219999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21246,null,"See CPT",null,1554.5893999999998,null,1554.5893999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21247,null,"See CPT",null,2887.0945999999999,null,2887.0945999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21248,null,"See CPT",null,1809.4205999999999,null,1440.8679999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21249,null,"See CPT",null,2443.5216,null,2010.0703999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21255,null,"See CPT",null,2460.1927999999998,null,2460.1927999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21256,null,"See CPT",null,2255.3751999999999,null,2255.3751999999999,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,1880.8686,null,1363.4659999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21275,null,"See CPT",null,1540.2998,null,1540.2998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21280,null,"See CPT",null,1081.8418000000001,null,1081.8418000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21282,null,"See CPT",null,738.89139999999998,null,738.89139999999998,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,285.79199999999997,null,108.95820000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[21320,null,"See CPT",null,410.82600000000002,null,171.4752,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[21325,null,"See CPT",null,835.34619999999995,null,835.34619999999995,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21330,null,"See CPT",null,998.48579999999993,null,998.48579999999993,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21335,null,"See CPT",null,1323.5742,null,1323.5742,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21336,null,"See CPT",null,1186.6322,null,1186.6322,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21337,null,"See CPT",null,787.71420000000001,null,559.0806,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21338,null,"See CPT",null,1256.2940000000001,null,1256.2940000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21339,null,"See CPT",null,1414.6704,null,1414.6704,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21340,null,"See CPT",null,1378.3509999999999,null,1378.3509999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21343,null,"See CPT",null,2008.8796,null,2008.8796,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21344,null,"See CPT",null,2548.3119999999999,null,2548.3119999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21345,null,"See CPT",null,1494.454,null,1177.1058,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21346,null,"See CPT",null,1908.8524000000002,null,1908.8524000000002,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21347,null,"See CPT",null,1920.7603999999999,null,1920.7603999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21348,null,"See CPT",null,1993.9946,null,1993.9946,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21355,null,"See CPT",null,840.10939999999994,null,607.30799999999999,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[21356,null,"See CPT",null,1019.3248000000001,null,744.25,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[21360,null,"See CPT",null,966.92959999999994,null,966.92959999999994,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21365,null,"See CPT",null,1971.9647999999997,null,1971.9647999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21366,null,"See CPT",null,2319.6784000000002,null,2319.6784000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[21385,null,"See CPT",null,1345.0085999999999,null,1345.0085999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21386,null,"See CPT",null,1264.0342000000001,null,1264.0342000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21387,null,"See CPT",null,1402.7623999999998,null,1402.7623999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21390,null,"See CPT",null,1472.4241999999999,null,1472.4241999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21395,null,"See CPT",null,1834.4273999999998,null,1834.4273999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21400,null,"See CPT",null,404.87199999999996,null,313.77579999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21401,null,"See CPT",null,960.38019999999995,null,609.0942,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21406,null,"See CPT",null,1072.9107999999999,null,1072.9107999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21407,null,"See CPT",null,1186.6322,null,1186.6322,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21408,null,"See CPT",null,1646.8763999999999,null,1646.8763999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[21421,null,"See CPT",null,1206.2804000000001,null,1013.9662000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21422,null,"See CPT",null,1155.6713999999999,null,1155.6713999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21423,null,"See CPT",null,1459.9207999999999,null,1459.9207999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21431,null,"See CPT",null,1290.8271999999999,null,1290.8271999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21432,null,"See CPT",null,1318.2156,null,1318.2156,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21433,null,"See CPT",null,3138.9487999999997,null,3138.9487999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21435,null,"See CPT",null,2559.0291999999999,null,2559.0291999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21436,null,"See CPT",null,3690.8845999999999,null,3690.8845999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21440,null,"See CPT",null,1309.2846,null,1047.904,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21445,null,"See CPT",null,1481.9506000000001,null,1190.8,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21450,null,"See CPT",null,1121.7336,null,907.38959999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21451,null,"See CPT",null,1453.3714,null,1207.4712,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21452,null,"See CPT",null,1428.3645999999999,null,882.97820000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21453,null,"See CPT",null,2073.7781999999997,null,1758.2162000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21454,null,"See CPT",null,893.1,null,893.1,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[21461,null,"See CPT",null,3484.2808,null,1983.8728000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21462,null,"See CPT",null,3765.9049999999997,null,2186.9041999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21465,null,"See CPT",null,1450.3943999999999,null,1450.3943999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21470,null,"See CPT",null,2114.8608000000004,null,2114.8608000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21480,null,"See CPT",null,270.3116,null,55.372199999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[21485,null,"See CPT",null,1849.3123999999998,null,1504.5757999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21490,null,"See CPT",null,1428.96,null,1428.96,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21497,null,"See CPT",null,1342.627,null,1111.6118000000001,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,915.12979999999993,null,618.62060000000008,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21502,null,"See CPT",null,914.53440000000001,null,914.53440000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21510,null,"See CPT",null,820.46119999999996,null,820.46119999999996,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21550,null,"See CPT",null,502.51759999999996,null,286.38739999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[21552,null,"See CPT",null,811.53020000000004,null,811.53020000000004,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21554,null,"See CPT",null,1324.1695999999999,null,1324.1695999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21555,null,"See CPT",null,811.53020000000004,null,563.84379999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[21556,null,"See CPT",null,969.3112000000001,null,969.3112000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[21557,null,"See CPT",null,1723.683,null,1723.683,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[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,1033.6143999999999,null,1033.6143999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21601,null,"See CPT",null,2044.0081999999998,null,2044.0081999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21602,null,"See CPT",null,2769.2053999999998,null,2769.2053999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21603,null,"See CPT",null,3009.7469999999998,null,3009.7469999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21610,null,"See CPT",null,2039.8403999999998,null,2039.8403999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21615,null,"See CPT",null,1104.4670000000001,null,1104.4670000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21616,null,"See CPT",null,1253.9123999999999,null,1253.9123999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21620,null,"See CPT",null,912.15279999999996,null,912.15279999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21627,null,"See CPT",null,991.93640000000005,null,991.93640000000005,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21630,null,"See CPT",null,2387.5540000000001,null,2387.5540000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21632,null,"See CPT",null,2153.5617999999999,null,2153.5617999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[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,626.36079999999993,null,626.36079999999993,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21705,null,"See CPT",null,931.2056,null,931.2056,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21720,null,"See CPT",null,971.69280000000003,null,971.69280000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21725,null,"See CPT",null,998.48579999999993,null,998.48579999999993,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21740,null,"See CPT",null,1808.8252,null,1808.8252,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[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-UR"]
[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-UR"]
[21750,null,"See CPT",null,1199.1356000000001,null,1199.1356000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21811,null,"See CPT",null,1042.5454,null,1042.5454,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21812,null,"See CPT",null,1264.6296,null,1264.6296,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21813,null,"See CPT",null,1724.8737999999998,null,1724.8737999999998,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21820,null,"See CPT",null,284.60120000000001,null,280.43340000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21825,null,"See CPT",null,996.10419999999999,null,996.10419999999999,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,482.27399999999994,null,284.00579999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[21925,null,"See CPT",null,920.48840000000007,null,694.2364,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21930,null,"See CPT",null,934.77799999999991,null,665.06179999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21931,null,"See CPT",null,850.82659999999998,null,850.82659999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[21932,null,"See CPT",null,1205.0895999999998,null,1205.0895999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21933,null,"See CPT",null,1334.2914000000001,null,1334.2914000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21935,null,"See CPT",null,1835.6181999999999,null,1835.6181999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[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,1754.0484000000001,null,1754.0484000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[22015,null,"See CPT",null,1727.2554,null,1727.2554,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[22100,null,"See CPT",null,1570.0698,null,1570.0698,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22101,null,"See CPT",null,1581.9777999999999,null,1581.9777999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22102,null,"See CPT",null,1417.0520000000001,null,1417.0520000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22103,null,"See CPT",null,238.75539999999998,null,238.75539999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22110,null,"See CPT",null,1920.165,null,1920.165,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22112,null,"See CPT",null,2052.3438000000001,null,2052.3438000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22114,null,"See CPT",null,2052.3438000000001,null,2052.3438000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22116,null,"See CPT",null,247.68639999999999,null,247.68639999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22206,null,"See CPT",null,4366.0681999999997,null,4366.0681999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22207,null,"See CPT",null,4286.88,null,4286.88,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22208,null,"See CPT",null,1032.4236000000001,null,1032.4236000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22210,null,"See CPT",null,3210.3968,null,3210.3968,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22212,null,"See CPT",null,2731.6952000000001,null,2731.6952000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22214,null,"See CPT",null,2731.6952000000001,null,2731.6952000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22216,null,"See CPT",null,638.26880000000006,null,638.26880000000006,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22220,null,"See CPT",null,2918.0553999999997,null,2918.0553999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22222,null,"See CPT",null,3161.5740000000001,null,3161.5740000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22224,null,"See CPT",null,2859.7062000000001,null,2859.7062000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22226,null,"See CPT",null,632.31479999999999,null,632.31479999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22310,null,"See CPT",null,577.5379999999999,null,550.745,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[22315,null,"See CPT",null,1634.9684,null,1412.8842,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[22318,null,"See CPT",null,2957.9472000000001,null,2957.9472000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22319,null,"See CPT",null,3275.2954,null,3275.2954,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22325,null,"See CPT",null,2660.8425999999999,null,2660.8425999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22326,null,"See CPT",null,2717.4056,null,2717.4056,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22327,null,"See CPT",null,2770.3962000000001,null,2770.3962000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22328,null,"See CPT",null,495.96820000000002,null,495.96820000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22505,null,"See CPT",null,235.7784,null,235.7784,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[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,3219.9231999999997,null,3219.9231999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22533,null,"See CPT",null,2979.3815999999997,null,2979.3815999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22534,null,"See CPT",null,634.101,null,634.101,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22548,null,"See CPT",null,3512.2646,null,3512.2646,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22551,null,"See CPT",null,3043.0893999999998,null,3043.0893999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22552,null,"See CPT",null,696.02260000000001,null,696.02260000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22554,null,"See CPT",null,2270.2602000000002,null,2270.2602000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22556,null,"See CPT",null,2997.2436000000002,null,2997.2436000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22558,null,"See CPT",null,2735.2675999999997,null,2735.2675999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22585,null,"See CPT",null,572.17939999999999,null,572.17939999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22586,null,"See CPT",null,3630.7491999999997,null,3630.7491999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22590,null,"See CPT",null,2854.9430000000002,null,2854.9430000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22595,null,"See CPT",null,2725.7411999999999,null,2725.7411999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22600,null,"See CPT",null,2348.2575999999999,null,2348.2575999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22610,null,"See CPT",null,2312.5336000000002,null,2312.5336000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22612,null,"See CPT",null,2844.2258000000002,null,2844.2258000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22614,null,"See CPT",null,687.09159999999997,null,687.09159999999997,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22630,null,"See CPT",null,2792.4259999999999,null,2792.4259999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22632,null,"See CPT",null,562.65299999999991,null,562.65299999999991,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22633,null,"See CPT",null,3236.5944,null,3236.5944,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22634,null,"See CPT",null,850.82659999999998,null,850.82659999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22800,null,"See CPT",null,2466.1468,null,2466.1468,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22802,null,"See CPT",null,3793.2934,null,3793.2934,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22804,null,"See CPT",null,4352.9694,null,4352.9694,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22808,null,"See CPT",null,3266.3643999999999,null,3266.3643999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22810,null,"See CPT",null,3612.2918,null,3612.2918,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22812,null,"See CPT",null,3960.0054000000005,null,3960.0054000000005,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22818,null,"See CPT",null,3859.3827999999994,null,3859.3827999999994,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22819,null,"See CPT",null,4445.2563999999993,null,4445.2563999999993,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22830,null,"See CPT",null,1488.5,null,1488.5,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22840,null,"See CPT",null,1332.5051999999998,null,1332.5051999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22841,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-UR"]
[22842,null,"See CPT",null,1341.4362000000001,null,1341.4362000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22843,null,"See CPT",null,1436.1048000000001,null,1436.1048000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22844,null,"See CPT",null,1737.3771999999999,null,1737.3771999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22845,null,"See CPT",null,1276.5376000000001,null,1276.5376000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22846,null,"See CPT",null,1328.3373999999999,null,1328.3373999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22847,null,"See CPT",null,1419.4336000000001,null,1419.4336000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22848,null,"See CPT",null,633.50560000000007,null,633.50560000000007,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22849,null,"See CPT",null,2345.8759999999997,null,2345.8759999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22850,null,"See CPT",null,1333.6959999999999,null,1333.6959999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22852,null,"See CPT",null,1284.8731999999998,null,1284.8731999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22853,null,"See CPT",null,453.69479999999999,null,453.69479999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22854,null,"See CPT",null,588.85059999999999,null,588.85059999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22855,null,"See CPT",null,1996.3761999999999,null,1996.3761999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22856,null,"See CPT",null,2909.7197999999999,null,2909.7197999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22857,null,"See CPT",null,3184.1991999999996,null,3184.1991999999996,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22858,null,"See CPT",null,891.31380000000001,null,891.31380000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22859,null,"See CPT",null,585.27819999999997,null,585.27819999999997,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22860,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,2,2,0,null,"X"]
[22861,null,"See CPT",null,4119.5725999999995,null,4119.5725999999995,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22862,null,"See CPT",null,4127.9081999999999,null,4127.9081999999999,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22864,null,"See CPT",null,3683.7397999999998,null,3683.7397999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22865,null,"See CPT",null,4030.8580000000002,null,4030.8580000000002,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22867,null,"See CPT",null,1937.4315999999999,null,1937.4315999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[22868,null,"See CPT",null,428.0926,null,428.0926,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22869,null,"See CPT",null,785.928,null,785.928,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[22870,null,"See CPT",null,211.36699999999999,null,211.36699999999999,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,1024.6834000000001,null,1024.6834000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22901,null,"See CPT",null,1201.5172,null,1201.5172,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22902,null,"See CPT",null,877.61959999999999,null,609.0942,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22903,null,"See CPT",null,799.02679999999998,null,799.02679999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[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-UR"]
[23000,null,"See CPT",null,1033.6143999999999,null,659.1078,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23020,null,"See CPT",null,1268.202,null,1268.202,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[23030,null,"See CPT",null,827.01060000000007,null,465.6028,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[23031,null,"See CPT",null,820.46119999999996,null,409.03980000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23035,null,"See CPT",null,1253.317,null,1253.317,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[23040,null,"See CPT",null,1318.2156,null,1318.2156,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23044,null,"See CPT",null,1046.7131999999999,null,1046.7131999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[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,1062.789,null,676.96979999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23071,null,"See CPT",null,764.49360000000001,null,764.49360000000001,null,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[23073,null,"See CPT",null,1265.8204000000001,null,1265.8204000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23075,null,"See CPT",null,966.92959999999994,null,603.14020000000005,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23076,null,"See CPT",null,994.31799999999998,null,994.31799999999998,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,940.13659999999993,null,940.13659999999993,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23101,null,"See CPT",null,847.84960000000001,null,847.84960000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23105,null,"See CPT",null,1177.1058,null,1177.1058,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23106,null,"See CPT",null,932.39639999999997,null,932.39639999999997,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23107,null,"See CPT",null,1217.5929999999998,null,1217.5929999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23120,null,"See CPT",null,1086.605,null,1086.605,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23125,null,"See CPT",null,1304.5214000000001,null,1304.5214000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23130,null,"See CPT",null,1143.7634,null,1143.7634,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23140,null,"See CPT",null,1027.0650000000001,null,1027.0650000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23145,null,"See CPT",null,1279.5146,null,1279.5146,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23146,null,"See CPT",null,1150.9081999999999,null,1150.9081999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[23150,null,"See CPT",null,1228.3101999999999,null,1228.3101999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23155,null,"See CPT",null,1464.0886,null,1464.0886,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23156,null,"See CPT",null,1249.7446,null,1249.7446,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[23170,null,"See CPT",null,1043.7362000000001,null,1043.7362000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23172,null,"See CPT",null,1055.0488,null,1055.0488,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[23174,null,"See CPT",null,1405.7393999999999,null,1405.7393999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23180,null,"See CPT",null,1211.0436,null,1211.0436,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23182,null,"See CPT",null,1240.2181999999998,null,1240.2181999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[23184,null,"See CPT",null,1361.6798000000001,null,1361.6798000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23190,null,"See CPT",null,1063.3843999999999,null,1063.3843999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23195,null,"See CPT",null,1362.2751999999998,null,1362.2751999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[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,569.79780000000005,null,309.01260000000002,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[23333,null,"See CPT",null,875.23799999999994,null,875.23799999999994,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[23334,null,"See CPT",null,1922.5465999999999,null,1922.5465999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23335,null,"See CPT",null,2295.2669999999998,null,2295.2669999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23350,null,"See CPT",null,312.58499999999998,null,89.31,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[23395,null,"See CPT",null,2329.2048,null,2329.2048,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[23397,null,"See CPT",null,2068.4196000000002,null,2068.4196000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[23400,null,"See CPT",null,1774.2919999999999,null,1774.2919999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23405,null,"See CPT",null,1133.0462,null,1133.0462,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[23406,null,"See CPT",null,1367.6337999999998,null,1367.6337999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[23410,null,"See CPT",null,1501.5988,null,1501.5988,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23412,null,"See CPT",null,1558.1618000000001,null,1558.1618000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23415,null,"See CPT",null,1285.4685999999999,null,1285.4685999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23420,null,"See CPT",null,1780.2459999999999,null,1780.2459999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23430,null,"See CPT",null,1365.8476000000001,null,1365.8476000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23440,null,"See CPT",null,1384.3050000000001,null,1384.3050000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23450,null,"See CPT",null,1721.8968,null,1721.8968,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23455,null,"See CPT",null,1798.1079999999999,null,1798.1079999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23460,null,"See CPT",null,1982.6819999999998,null,1982.6819999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23462,null,"See CPT",null,1938.6224000000002,null,1938.6224000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23465,null,"See CPT",null,2032.6956,null,2032.6956,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23466,null,"See CPT",null,2044.6036000000001,null,2044.6036000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23470,null,"See CPT",null,2170.8283999999999,null,2170.8283999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23472,null,"See CPT",null,2612.6152000000002,null,2612.6152000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23473,null,"See CPT",null,2904.9566,null,2904.9566,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23474,null,"See CPT",null,3132.9947999999999,null,3132.9947999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23480,null,"See CPT",null,1499.8126,null,1499.8126,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[23485,null,"See CPT",null,1736.7818,null,1736.7818,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23490,null,"See CPT",null,1572.4513999999999,null,1572.4513999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[23491,null,"See CPT",null,1850.5031999999999,null,1850.5031999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23500,null,"See CPT",null,426.90179999999998,null,436.4282,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23505,null,"See CPT",null,679.94679999999994,null,629.33780000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23515,null,"See CPT",null,1325.3604,null,1325.3604,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23520,null,"See CPT",null,459.64879999999999,null,454.29019999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23525,null,"See CPT",null,753.77639999999997,null,687.09159999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23530,null,"See CPT",null,1064.5752,null,1064.5752,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23532,null,"See CPT",null,1156.2668000000001,null,1156.2668000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23540,null,"See CPT",null,457.2672,null,451.90859999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23545,null,"See CPT",null,685.30539999999996,null,611.47579999999994,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23550,null,"See CPT",null,1056.835,null,1056.835,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23552,null,"See CPT",null,1192.5862,null,1192.5862,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23570,null,"See CPT",null,447.1454,null,462.03039999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23575,null,"See CPT",null,777.5924,null,715.07539999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23585,null,"See CPT",null,1778.4598000000001,null,1778.4598000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23600,null,"See CPT",null,637.67340000000002,null,602.5447999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23605,null,"See CPT",null,887.7414,null,801.40840000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23615,null,"See CPT",null,1615.3201999999999,null,1615.3201999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23616,null,"See CPT",null,2241.0855999999999,null,2241.0855999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[23620,null,"See CPT",null,518.59340000000009,null,495.96820000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23625,null,"See CPT",null,735.31899999999996,null,669.82500000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23630,null,"See CPT",null,1433.1278,null,1433.1278,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23650,null,"See CPT",null,629.33780000000002,null,565.03459999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23655,null,"See CPT",null,763.30280000000005,null,763.30280000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23660,null,"See CPT",null,1083.6279999999999,null,1083.6279999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23665,null,"See CPT",null,820.46119999999996,null,750.20399999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23670,null,"See CPT",null,1592.0995999999998,null,1592.0995999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23675,null,"See CPT",null,1034.8052,null,932.39639999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23680,null,"See CPT",null,1696.8899999999999,null,1696.8899999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23700,null,"See CPT",null,360.81239999999997,null,360.81239999999997,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23800,null,"See CPT",null,1870.1514,null,1870.1514,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23802,null,"See CPT",null,2330.991,null,2330.991,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23900,null,"See CPT",null,2506.0386000000003,null,2506.0386000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[23920,null,"See CPT",null,2040.4358000000002,null,2040.4358000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23921,null,"See CPT",null,874.04719999999998,null,874.04719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23929,null,"See CPT",null,0,null,0,null,"000",0,0,0,0,2,0,2,1,1,null,"B",null,"Y-UR"]
[23930,null,"See CPT",null,675.779,null,392.964,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23931,null,"See CPT",null,575.7518,null,298.89079999999996,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23935,null,"See CPT",null,952.04459999999995,null,952.04459999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24000,null,"See CPT",null,886.55060000000003,null,886.55060000000003,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR"]
[24006,null,"See CPT",null,1309.2846,null,1309.2846,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[24065,null,"See CPT",null,485.84640000000002,null,298.29539999999997,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[24066,null,"See CPT",null,1168.7701999999999,null,775.80619999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24071,null,"See CPT",null,738.89139999999998,null,738.89139999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24073,null,"See CPT",null,1258.6756,null,1258.6756,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24075,null,"See CPT",null,1002.6536,null,607.30799999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24076,null,"See CPT",null,1003.8444,null,1003.8444,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,781.1647999999999,null,781.1647999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24101,null,"See CPT",null,936.56420000000003,null,936.56420000000003,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24102,null,"See CPT",null,1136.0231999999999,null,1136.0231999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24105,null,"See CPT",null,675.779,null,675.779,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24110,null,"See CPT",null,1091.9636,null,1091.9636,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24115,null,"See CPT",null,1353.3442,null,1353.3442,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24116,null,"See CPT",null,1570.6651999999999,null,1570.6651999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24120,null,"See CPT",null,986.57780000000002,null,986.57780000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24125,null,"See CPT",null,1149.1220000000001,null,1149.1220000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24126,null,"See CPT",null,1199.1356000000001,null,1199.1356000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24130,null,"See CPT",null,952.04459999999995,null,952.04459999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[24134,null,"See CPT",null,1371.8016,null,1371.8016,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24136,null,"See CPT",null,1165.7931999999998,null,1165.7931999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24138,null,"See CPT",null,1272.9651999999999,null,1272.9651999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24140,null,"See CPT",null,1293.8042,null,1293.8042,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24145,null,"See CPT",null,1097.3222000000001,null,1097.3222000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24147,null,"See CPT",null,1165.1977999999999,null,1165.1977999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24149,null,"See CPT",null,2158.9204,null,2158.9204,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,1556.3756000000001,null,1556.3756000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24160,null,"See CPT",null,2279.1912000000002,null,2279.1912000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24164,null,"See CPT",null,1328.9328,null,1328.9328,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24200,null,"See CPT",null,405.4674,null,256.61739999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[24201,null,"See CPT",null,1029.4466,null,676.96979999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24220,null,"See CPT",null,362.59859999999998,null,119.08,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[24300,null,"See CPT",null,824.03359999999998,null,824.03359999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24301,null,"See CPT",null,1380.7326,null,1380.7326,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[24305,null,"See CPT",null,1070.5291999999999,null,1070.5291999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[24310,null,"See CPT",null,881.19200000000001,null,881.19200000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[24320,null,"See CPT",null,1429.5554,null,1429.5554,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[24330,null,"See CPT",null,1319.4064000000001,null,1319.4064000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24331,null,"See CPT",null,1438.4864,null,1438.4864,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24332,null,"See CPT",null,1137.8093999999999,null,1137.8093999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[24340,null,"See CPT",null,1107.444,null,1107.444,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24341,null,"See CPT",null,1380.1371999999999,null,1380.1371999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24342,null,"See CPT",null,1418.8381999999999,null,1418.8381999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24343,null,"See CPT",null,1320.0018,null,1320.0018,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24344,null,"See CPT",null,1996.9715999999999,null,1996.9715999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24345,null,"See CPT",null,1311.6662000000001,null,1311.6662000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24346,null,"See CPT",null,2017.8106,null,2017.8106,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24357,null,"See CPT",null,778.18780000000004,null,778.18780000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24358,null,"See CPT",null,981.2192,null,981.2192,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24359,null,"See CPT",null,1221.1654000000001,null,1221.1654000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24360,null,"See CPT",null,1649.8534,null,1649.8534,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24361,null,"See CPT",null,1836.2136,null,1836.2136,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24362,null,"See CPT",null,1930.8822,null,1930.8822,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24363,null,"See CPT",null,2620.9508000000001,null,2620.9508000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24365,null,"See CPT",null,1179.4874,null,1179.4874,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24366,null,"See CPT",null,1251.5308,null,1251.5308,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24370,null,"See CPT",null,2781.1134000000002,null,2781.1134000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24371,null,"See CPT",null,3188.3669999999997,null,3188.3669999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24400,null,"See CPT",null,1517.0791999999999,null,1517.0791999999999,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,1957.6752000000001,null,1957.6752000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24430,null,"See CPT",null,1921.9512,null,1921.9512,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24435,null,"See CPT",null,1970.7740000000001,null,1970.7740000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24470,null,"See CPT",null,1237.8365999999999,null,1237.8365999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24495,null,"See CPT",null,1736.1864,null,1736.1864,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24498,null,"See CPT",null,1583.1686,null,1583.1686,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24500,null,"See CPT",null,690.66399999999999,null,635.29179999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24505,null,"See CPT",null,950.85379999999998,null,848.44499999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24515,null,"See CPT",null,1613.5340000000001,null,1613.5340000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24516,null,"See CPT",null,1569.4743999999998,null,1569.4743999999998,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[24530,null,"See CPT",null,730.55579999999998,null,666.84799999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24535,null,"See CPT",null,1163.4115999999999,null,1063.3843999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24538,null,"See CPT",null,1460.5162,null,1460.5162,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24545,null,"See CPT",null,1693.3176000000001,null,1693.3176000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24546,null,"See CPT",null,1888.6088,null,1888.6088,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[24560,null,"See CPT",null,638.26880000000006,null,562.65299999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24565,null,"See CPT",null,1020.5156000000001,null,927.63319999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24566,null,"See CPT",null,1331.9098000000001,null,1331.9098000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24575,null,"See CPT",null,1347.9856,null,1347.9856,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24576,null,"See CPT",null,672.80200000000002,null,597.18619999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24577,null,"See CPT",null,1048.4993999999999,null,950.85379999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24579,null,"See CPT",null,1530.7734,null,1530.7734,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24582,null,"See CPT",null,1508.7436,null,1508.7436,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24586,null,"See CPT",null,1977.3234,null,1977.3234,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24587,null,"See CPT",null,1979.7049999999999,null,1979.7049999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24600,null,"See CPT",null,713.28920000000005,null,641.84119999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24605,null,"See CPT",null,893.1,null,893.1,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24615,null,"See CPT",null,1311.6662000000001,null,1311.6662000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24620,null,"See CPT",null,1092.559,null,1092.559,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24635,null,"See CPT",null,1247.9584,null,1247.9584,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,506.68539999999996,null,469.7706,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24655,null,"See CPT",null,849.04039999999998,null,761.51659999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24665,null,"See CPT",null,1215.2113999999999,null,1215.2113999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24666,null,"See CPT",null,1347.3901999999998,null,1347.3901999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24670,null,"See CPT",null,559.67600000000004,null,510.25780000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24675,null,"See CPT",null,871.0702,null,784.73719999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24685,null,"See CPT",null,1207.4712,null,1207.4712,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24800,null,"See CPT",null,1527.7963999999999,null,1527.7963999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24802,null,"See CPT",null,1827.2826,null,1827.2826,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24900,null,"See CPT",null,1349.7718,null,1349.7718,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24920,null,"See CPT",null,1344.4132,null,1344.4132,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24925,null,"See CPT",null,1053.2626,null,1053.2626,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24930,null,"See CPT",null,1415.2657999999999,null,1415.2657999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24931,null,"See CPT",null,1695.1037999999999,null,1695.1037999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24935,null,"See CPT",null,2238.1086,null,2238.1086,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24940,null,"See CPT",null,2043.8668358222403,null,2043.8668358222403,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,650.7722,null,650.7722,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25001,null,"See CPT",null,649.58140000000003,null,649.58140000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25020,null,"See CPT",null,1403.3578,null,1403.3578,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25023,null,"See CPT",null,2431.0182,null,2431.0182,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[25024,null,"See CPT",null,1418.2428,null,1418.2428,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25025,null,"See CPT",null,2227.9868000000001,null,2227.9868000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[25028,null,"See CPT",null,1308.6892,null,1308.6892,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25031,null,"See CPT",null,687.68700000000001,null,687.68700000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25035,null,"See CPT",null,1083.6279999999999,null,1083.6279999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25040,null,"See CPT",null,1031.8281999999999,null,1031.8281999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25065,null,"See CPT",null,481.08319999999998,null,290.55520000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[25066,null,"See CPT",null,684.71,null,684.71,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25071,null,"See CPT",null,774.61540000000002,null,774.61540000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25073,null,"See CPT",null,987.17319999999984,null,987.17319999999984,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25075,null,"See CPT",null,980.02840000000003,null,584.0874,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25076,null,"See CPT",null,959.78480000000002,null,959.78480000000002,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,832.96460000000002,null,832.96460000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25100,null,"See CPT",null,654.34460000000001,null,654.34460000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25101,null,"See CPT",null,754.96719999999993,null,754.96719999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25105,null,"See CPT",null,907.38959999999997,null,907.38959999999997,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25107,null,"See CPT",null,1145.5495999999998,null,1145.5495999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25109,null,"See CPT",null,993.72260000000006,null,993.72260000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25110,null,"See CPT",null,648.98599999999999,null,648.98599999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25111,null,"See CPT",null,609.68960000000004,null,609.68960000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25112,null,"See CPT",null,728.17420000000004,null,728.17420000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25115,null,"See CPT",null,1394.4268000000002,null,1394.4268000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25116,null,"See CPT",null,1119.9474,null,1119.9474,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25118,null,"See CPT",null,715.07539999999995,null,715.07539999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25119,null,"See CPT",null,932.99180000000001,null,932.99180000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25120,null,"See CPT",null,932.39639999999997,null,932.39639999999997,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25125,null,"See CPT",null,1100.8945999999999,null,1100.8945999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25126,null,"See CPT",null,1108.6348,null,1108.6348,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25130,null,"See CPT",null,841.89560000000006,null,841.89560000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25135,null,"See CPT",null,1037.7821999999999,null,1037.7821999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25136,null,"See CPT",null,924.6561999999999,null,924.6561999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25145,null,"See CPT",null,966.33420000000001,null,966.33420000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25150,null,"See CPT",null,1049.6902,null,1049.6902,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25151,null,"See CPT",null,1081.2464,null,1081.2464,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,917.51139999999998,null,917.51139999999998,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25215,null,"See CPT",null,1145.5495999999998,null,1145.5495999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25230,null,"See CPT",null,806.1715999999999,null,806.1715999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25240,null,"See CPT",null,800.81299999999999,null,800.81299999999999,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25246,null,"See CPT",null,373.31579999999997,null,129.7972,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[25248,null,"See CPT",null,769.85219999999993,null,769.85219999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25250,null,"See CPT",null,988.95939999999996,null,988.95939999999996,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25251,null,"See CPT",null,1321.788,null,1321.788,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25259,null,"See CPT",null,815.69799999999998,null,815.69799999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25260,null,"See CPT",null,1177.7012,null,1177.7012,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25263,null,"See CPT",null,1172.9379999999999,null,1172.9379999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[25265,null,"See CPT",null,1381.328,null,1381.328,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[25270,null,"See CPT",null,918.70219999999995,null,918.70219999999995,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[25272,null,"See CPT",null,1035.9959999999999,null,1035.9959999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[25274,null,"See CPT",null,1228.9056,null,1228.9056,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25275,null,"See CPT",null,1240.2181999999998,null,1240.2181999999998,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25280,null,"See CPT",null,1047.904,null,1047.904,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25290,null,"See CPT",null,810.9348,null,810.9348,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25295,null,"See CPT",null,978.24220000000003,null,978.24220000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25300,null,"See CPT",null,1273.5606,null,1273.5606,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25301,null,"See CPT",null,1187.8229999999999,null,1187.8229999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25310,null,"See CPT",null,1149.7174,null,1149.7174,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[25312,null,"See CPT",null,1320.5971999999999,null,1320.5971999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[25315,null,"See CPT",null,1411.098,null,1411.098,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25316,null,"See CPT",null,1674.2647999999999,null,1674.2647999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25320,null,"See CPT",null,1820.7331999999999,null,1820.7331999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[25332,null,"See CPT",null,1550.4215999999999,null,1550.4215999999999,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,1635.5637999999999,null,1635.5637999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25350,null,"See CPT",null,1244.9813999999999,null,1244.9813999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25355,null,"See CPT",null,1402.7623999999998,null,1402.7623999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25360,null,"See CPT",null,1209.8527999999999,null,1209.8527999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25365,null,"See CPT",null,1676.0509999999999,null,1676.0509999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25370,null,"See CPT",null,1850.5031999999999,null,1850.5031999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25375,null,"See CPT",null,1740.9495999999999,null,1740.9495999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25390,null,"See CPT",null,1411.6934000000001,null,1411.6934000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25391,null,"See CPT",null,1815.3745999999999,null,1815.3745999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25392,null,"See CPT",null,1846.9307999999999,null,1846.9307999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25393,null,"See CPT",null,2051.1530000000002,null,2051.1530000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25394,null,"See CPT",null,1437.2955999999999,null,1437.2955999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25400,null,"See CPT",null,1471.8288,null,1471.8288,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25405,null,"See CPT",null,1890.395,null,1890.395,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25415,null,"See CPT",null,1765.9564,null,1765.9564,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25420,null,"See CPT",null,2117.2424000000001,null,2117.2424000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25425,null,"See CPT",null,1758.2162000000001,null,1758.2162000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25426,null,"See CPT",null,2039.8403999999998,null,2039.8403999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25430,null,"See CPT",null,1346.7948000000001,null,1346.7948000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25431,null,"See CPT",null,1443.845,null,1443.845,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25440,null,"See CPT",null,1411.098,null,1411.098,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25441,null,"See CPT",null,1713.5612000000001,null,1713.5612000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25442,null,"See CPT",null,1486.7138,null,1486.7138,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25443,null,"See CPT",null,1442.6541999999999,null,1442.6541999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25444,null,"See CPT",null,1518.27,null,1518.27,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25445,null,"See CPT",null,1326.5512000000001,null,1326.5512000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25446,null,"See CPT",null,2132.7228,null,2132.7228,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25447,null,"See CPT",null,1531.3688,null,1531.3688,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25449,null,"See CPT",null,1885.0364,null,1885.0364,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25450,null,"See CPT",null,1140.7864,null,1140.7864,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[25455,null,"See CPT",null,1345.0085999999999,null,1345.0085999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[25490,null,"See CPT",null,1321.788,null,1321.788,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25491,null,"See CPT",null,1356.3212000000001,null,1356.3212000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25492,null,"See CPT",null,1657.5935999999999,null,1657.5935999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25500,null,"See CPT",null,544.79100000000005,null,491.20499999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25505,null,"See CPT",null,959.78480000000002,null,866.90240000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25515,null,"See CPT",null,1236.0504000000001,null,1236.0504000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25520,null,"See CPT",null,1084.2234000000001,null,1018.134,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25525,null,"See CPT",null,1455.7529999999999,null,1455.7529999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25526,null,"See CPT",null,1750.4759999999999,null,1750.4759999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25530,null,"See CPT",null,507.28079999999994,null,464.41199999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25535,null,"See CPT",null,935.96879999999999,null,859.16219999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25545,null,"See CPT",null,1157.4576,null,1157.4576,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25560,null,"See CPT",null,556.10360000000003,null,494.18200000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25565,null,"See CPT",null,981.81459999999993,null,872.85640000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25574,null,"See CPT",null,1247.9584,null,1247.9584,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25575,null,"See CPT",null,1658.7844,null,1658.7844,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25600,null,"See CPT",null,650.7722,null,621.00220000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25605,null,"See CPT",null,1016.3478,null,957.40319999999986,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25606,null,"See CPT",null,1239.0273999999999,null,1239.0273999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25607,null,"See CPT",null,1366.443,null,1366.443,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25608,null,"See CPT",null,1522.4377999999999,null,1522.4377999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25609,null,"See CPT",null,1928.5006000000001,null,1928.5006000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25622,null,"See CPT",null,589.44600000000003,null,543.00479999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25624,null,"See CPT",null,931.2056,null,840.10939999999994,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25628,null,"See CPT",null,1325.3604,null,1325.3604,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25630,null,"See CPT",null,584.0874,null,541.81399999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25635,null,"See CPT",null,882.97820000000002,null,797.24059999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25645,null,"See CPT",null,1057.4304000000002,null,1057.4304000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25650,null,"See CPT",null,632.31479999999999,null,583.49200000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25651,null,"See CPT",null,913.93899999999996,null,913.93899999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25652,null,"See CPT",null,1152.6943999999999,null,1152.6943999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25660,null,"See CPT",null,843.68179999999995,null,843.68179999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25670,null,"See CPT",null,1124.1152,null,1124.1152,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25671,null,"See CPT",null,988.36400000000003,null,988.36400000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25675,null,"See CPT",null,863.92539999999997,null,774.61540000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25676,null,"See CPT",null,1165.1977999999999,null,1165.1977999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25680,null,"See CPT",null,991.34099999999989,null,991.34099999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25685,null,"See CPT",null,1349.7718,null,1349.7718,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25690,null,"See CPT",null,919.89299999999992,null,919.89299999999992,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25695,null,"See CPT",null,1168.7701999999999,null,1168.7701999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25800,null,"See CPT",null,1346.7948000000001,null,1346.7948000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25805,null,"See CPT",null,1552.8031999999998,null,1552.8031999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25810,null,"See CPT",null,1590.9087999999999,null,1590.9087999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25820,null,"See CPT",null,1209.2574,null,1209.2574,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25825,null,"See CPT",null,1471.8288,null,1471.8288,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25830,null,"See CPT",null,1890.395,null,1890.395,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25900,null,"See CPT",null,1317.0248000000001,null,1317.0248000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25905,null,"See CPT",null,1288.4456,null,1288.4456,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25907,null,"See CPT",null,1133.6415999999999,null,1133.6415999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25909,null,"See CPT",null,1260.4618,null,1260.4618,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25915,null,"See CPT",null,2114.2653999999998,null,2114.2653999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25920,null,"See CPT",null,1351.558,null,1351.558,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25922,null,"See CPT",null,1200.9218000000001,null,1200.9218000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25924,null,"See CPT",null,1320.0018,null,1320.0018,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25927,null,"See CPT",null,1614.7248,null,1614.7248,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25929,null,"See CPT",null,1105.6578,null,1105.6578,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25931,null,"See CPT",null,1498.0264,null,1498.0264,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,658.51240000000007,null,261.976,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[26011,null,"See CPT",null,920.48840000000007,null,343.54579999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[26020,null,"See CPT",null,1032.4236000000001,null,1032.4236000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26025,null,"See CPT",null,779.97399999999993,null,779.97399999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26030,null,"See CPT",null,910.96199999999999,null,910.96199999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26034,null,"See CPT",null,1024.6834000000001,null,1024.6834000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26035,null,"See CPT",null,1581.3824,null,1581.3824,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26037,null,"See CPT",null,1035.4005999999999,null,1035.4005999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26040,null,"See CPT",null,594.20920000000001,null,594.20920000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26045,null,"See CPT",null,879.4058,null,879.4058,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26055,null,"See CPT",null,1128.8784000000001,null,546.57719999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26060,null,"See CPT",null,478.70159999999993,null,478.70159999999993,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26070,null,"See CPT",null,603.73559999999998,null,603.73559999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26075,null,"See CPT",null,634.69640000000004,null,634.69640000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26080,null,"See CPT",null,746.03620000000001,null,746.03620000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26100,null,"See CPT",null,635.88720000000001,null,635.88720000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26105,null,"See CPT",null,640.65039999999999,null,640.65039999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26110,null,"See CPT",null,610.88040000000001,null,610.88040000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26111,null,"See CPT",null,767.47059999999999,null,767.47059999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26113,null,"See CPT",null,1010.3937999999999,null,1010.3937999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26115,null,"See CPT",null,1041.3545999999999,null,617.4298,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26116,null,"See CPT",null,972.8836,null,972.8836,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,1110.4209999999998,null,1110.4209999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26123,null,"See CPT",null,1546.2538,null,1546.2538,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26125,null,"See CPT",null,480.48779999999999,null,480.48779999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[26130,null,"See CPT",null,874.04719999999998,null,874.04719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26135,null,"See CPT",null,1027.6604,null,1027.6604,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26140,null,"See CPT",null,943.70899999999995,null,943.70899999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26145,null,"See CPT",null,958.59400000000005,null,958.59400000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26160,null,"See CPT",null,1173.5334,null,591.23219999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26170,null,"See CPT",null,762.70740000000001,null,762.70740000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26180,null,"See CPT",null,839.51400000000001,null,839.51400000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26185,null,"See CPT",null,1036.5914,null,1036.5914,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26200,null,"See CPT",null,838.91859999999997,null,838.91859999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26205,null,"See CPT",null,1116.9704000000002,null,1116.9704000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26210,null,"See CPT",null,836.53700000000003,null,836.53700000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26215,null,"See CPT",null,1050.8809999999999,null,1050.8809999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26230,null,"See CPT",null,927.63319999999999,null,927.63319999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26235,null,"See CPT",null,913.93899999999996,null,913.93899999999996,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26236,null,"See CPT",null,819.86579999999992,null,819.86579999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26250,null,"See CPT",null,1938.6224000000002,null,1938.6224000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26260,null,"See CPT",null,1456.3484000000001,null,1456.3484000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26262,null,"See CPT",null,1160.4345999999998,null,1160.4345999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26320,null,"See CPT",null,653.15380000000005,null,653.15380000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26340,null,"See CPT",null,673.99279999999999,null,673.99279999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26341,null,"See CPT",null,221.4888,null,144.68219999999999,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[26350,null,"See CPT",null,1415.8612000000001,null,1415.8612000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26352,null,"See CPT",null,1571.856,null,1571.856,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26356,null,"See CPT",null,1477.1873999999998,null,1477.1873999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26357,null,"See CPT",null,1647.4718,null,1647.4718,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26358,null,"See CPT",null,1811.2068000000002,null,1811.2068000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26370,null,"See CPT",null,1481.3552,null,1481.3552,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26372,null,"See CPT",null,1719.5151999999998,null,1719.5151999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26373,null,"See CPT",null,1658.1890000000001,null,1658.1890000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26390,null,"See CPT",null,1642.1131999999998,null,1642.1131999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26392,null,"See CPT",null,1873.1284000000001,null,1873.1284000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26410,null,"See CPT",null,1144.3588,null,1144.3588,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26412,null,"See CPT",null,1356.3212000000001,null,1356.3212000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26415,null,"See CPT",null,1599.2444,null,1599.2444,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26416,null,"See CPT",null,1725.4692,null,1725.4692,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26418,null,"See CPT",null,1191.3954000000001,null,1191.3954000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26420,null,"See CPT",null,1402.7623999999998,null,1402.7623999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26426,null,"See CPT",null,936.56420000000003,null,936.56420000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26428,null,"See CPT",null,1502.7895999999998,null,1502.7895999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26432,null,"See CPT",null,1037.7821999999999,null,1037.7821999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26433,null,"See CPT",null,1088.9866,null,1088.9866,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26434,null,"See CPT",null,1315.2385999999999,null,1315.2385999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26437,null,"See CPT",null,1262.8434,null,1262.8434,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26440,null,"See CPT",null,1238.432,null,1238.432,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26442,null,"See CPT",null,1860.625,null,1860.625,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26445,null,"See CPT",null,1158.0529999999999,null,1158.0529999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26449,null,"See CPT",null,1296.1858,null,1296.1858,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26450,null,"See CPT",null,884.16899999999998,null,884.16899999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26455,null,"See CPT",null,879.4058,null,879.4058,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26460,null,"See CPT",null,855.58979999999997,null,855.58979999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26471,null,"See CPT",null,1250.3399999999999,null,1250.3399999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26474,null,"See CPT",null,1236.6458,null,1236.6458,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26476,null,"See CPT",null,1221.1654000000001,null,1221.1654000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26477,null,"See CPT",null,1187.8229999999999,null,1187.8229999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26478,null,"See CPT",null,1256.2940000000001,null,1256.2940000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26479,null,"See CPT",null,1278.9192,null,1278.9192,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26480,null,"See CPT",null,1486.7138,null,1486.7138,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26483,null,"See CPT",null,1639.1362000000001,null,1639.1362000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26485,null,"See CPT",null,1576.6192000000001,null,1576.6192000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26489,null,"See CPT",null,1807.6343999999999,null,1807.6343999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26490,null,"See CPT",null,1573.6422,null,1573.6422,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26492,null,"See CPT",null,1735.5909999999999,null,1735.5909999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26494,null,"See CPT",null,1579.5962,null,1579.5962,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26496,null,"See CPT",null,1695.6992,null,1695.6992,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26497,null,"See CPT",null,1693.913,null,1693.913,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26498,null,"See CPT",null,2185.1179999999999,null,2185.1179999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26499,null,"See CPT",null,1633.7776000000001,null,1633.7776000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26500,null,"See CPT",null,1253.317,null,1253.317,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26502,null,"See CPT",null,1423.6014,null,1423.6014,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26508,null,"See CPT",null,1280.7054000000001,null,1280.7054000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26510,null,"See CPT",null,1217.5929999999998,null,1217.5929999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26516,null,"See CPT",null,1400.9762000000001,null,1400.9762000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26517,null,"See CPT",null,1624.2512000000002,null,1624.2512000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26518,null,"See CPT",null,1643.8994,null,1643.8994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26520,null,"See CPT",null,1297.972,null,1297.972,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26525,null,"See CPT",null,1302.7351999999998,null,1302.7351999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26530,null,"See CPT",null,1001.4628,null,1001.4628,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26531,null,"See CPT",null,1169.3656000000001,null,1169.3656000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26535,null,"See CPT",null,816.29340000000002,null,816.29340000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26536,null,"See CPT",null,1418.8381999999999,null,1418.8381999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26540,null,"See CPT",null,1321.788,null,1321.788,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[26541,null,"See CPT",null,1563.5204000000001,null,1563.5204000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26542,null,"See CPT",null,1361.0844,null,1361.0844,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26545,null,"See CPT",null,1381.9234000000001,null,1381.9234000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26546,null,"See CPT",null,1943.981,null,1943.981,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26548,null,"See CPT",null,1503.9804000000001,null,1503.9804000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26550,null,"See CPT",null,3037.1353999999997,null,3037.1353999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26551,null,"See CPT",null,5971.8620000000001,null,5971.8620000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26553,null,"See CPT",null,5931.9701999999997,null,5931.9701999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26554,null,"See CPT",null,6894.732,null,6894.732,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26555,null,"See CPT",null,2563.7924000000003,null,2563.7924000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26556,null,"See CPT",null,6171.3209999999999,null,6171.3209999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26560,null,"See CPT",null,1205.0895999999998,null,1205.0895999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26561,null,"See CPT",null,1832.0457999999999,null,1832.0457999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26562,null,"See CPT",null,2544.7395999999999,null,2544.7395999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26565,null,"See CPT",null,1346.1994,null,1346.1994,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26567,null,"See CPT",null,1356.9166,null,1356.9166,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26568,null,"See CPT",null,1747.499,null,1747.499,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,931.2056,null,931.2056,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26593,null,"See CPT",null,1222.9515999999999,null,1222.9515999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26596,null,"See CPT",null,1526.0101999999999,null,1526.0101999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26600,null,"See CPT",null,577.5379999999999,null,548.9588,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26605,null,"See CPT",null,631.71939999999995,null,566.82079999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26607,null,"See CPT",null,954.42620000000011,null,954.42620000000011,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26608,null,"See CPT",null,900.84019999999998,null,900.84019999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26615,null,"See CPT",null,1068.7429999999999,null,1068.7429999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26641,null,"See CPT",null,796.04979999999989,null,721.02940000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26645,null,"See CPT",null,819.86579999999992,null,743.05920000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26650,null,"See CPT",null,904.4126,null,904.4126,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26665,null,"See CPT",null,1163.4115999999999,null,1163.4115999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[26670,null,"See CPT",null,660.89400000000001,null,587.06439999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26675,null,"See CPT",null,874.6425999999999,null,794.2636,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26676,null,"See CPT",null,956.21239999999989,null,956.21239999999989,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26685,null,"See CPT",null,1068.7429999999999,null,1068.7429999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26686,null,"See CPT",null,1149.7174,null,1149.7174,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26700,null,"See CPT",null,644.81820000000005,null,590.63679999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26705,null,"See CPT",null,830.58299999999997,null,747.82240000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26706,null,"See CPT",null,836.53700000000003,null,836.53700000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26715,null,"See CPT",null,1065.1705999999999,null,1065.1705999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26720,null,"See CPT",null,385.81920000000002,null,361.40780000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26725,null,"See CPT",null,651.36759999999992,null,576.34719999999993,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26727,null,"See CPT",null,888.93219999999997,null,888.93219999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26735,null,"See CPT",null,1103.2762,null,1103.2762,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26740,null,"See CPT",null,446.55,null,422.73399999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26742,null,"See CPT",null,710.31219999999996,null,634.101,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26746,null,"See CPT",null,1368.8245999999999,null,1368.8245999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26750,null,"See CPT",null,359.6216,null,363.19399999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26755,null,"See CPT",null,610.28499999999997,null,519.78420000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26756,null,"See CPT",null,799.02679999999998,null,799.02679999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26765,null,"See CPT",null,938.94579999999996,null,938.94579999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26770,null,"See CPT",null,546.57719999999995,null,495.37279999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26775,null,"See CPT",null,753.18100000000004,null,672.20659999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26776,null,"See CPT",null,844.87259999999992,null,844.87259999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26785,null,"See CPT",null,1020.5156000000001,null,1020.5156000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26820,null,"See CPT",null,1557.5663999999999,null,1557.5663999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26841,null,"See CPT",null,1456.3484000000001,null,1456.3484000000001,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[26842,null,"See CPT",null,1562.3295999999998,null,1562.3295999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26843,null,"See CPT",null,1470.6379999999999,null,1470.6379999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26844,null,"See CPT",null,1612.9386,null,1612.9386,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26850,null,"See CPT",null,1384.9004,null,1384.9004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26852,null,"See CPT",null,1564.7112,null,1564.7112,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26860,null,"See CPT",null,1164.6024,null,1164.6024,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26861,null,"See CPT",null,180.40619999999998,null,180.40619999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[26862,null,"See CPT",null,1442.0588,null,1442.0588,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26863,null,"See CPT",null,406.65820000000002,null,406.65820000000002,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[26910,null,"See CPT",null,1433.1278,null,1433.1278,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26951,null,"See CPT",null,1325.9558,null,1325.9558,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26952,null,"See CPT",null,1291.4226000000001,null,1291.4226000000001,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,1259.8663999999999,null,1259.8663999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26991,null,"See CPT",null,1325.3604,null,970.50200000000007,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26992,null,"See CPT",null,1845.1445999999999,null,1845.1445999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[27000,null,"See CPT",null,726.38799999999992,null,726.38799999999992,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27001,null,"See CPT",null,996.69959999999992,null,996.69959999999992,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27003,null,"See CPT",null,1105.6578,null,1105.6578,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27005,null,"See CPT",null,1311.0708,null,1311.0708,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27006,null,"See CPT",null,1307.4983999999999,null,1307.4983999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27025,null,"See CPT",null,1682.0049999999999,null,1682.0049999999999,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27027,null,"See CPT",null,1623.6558,null,1623.6558,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27030,null,"See CPT",null,1704.0348000000001,null,1704.0348000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27033,null,"See CPT",null,1767.7426,null,1767.7426,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27035,null,"See CPT",null,2067.8241999999996,null,2067.8241999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27036,null,"See CPT",null,1854.0755999999999,null,1854.0755999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27040,null,"See CPT",null,636.48259999999993,null,362.59859999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27041,null,"See CPT",null,1297.3765999999998,null,1297.3765999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27043,null,"See CPT",null,850.82659999999998,null,850.82659999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27045,null,"See CPT",null,1333.1006,null,1333.1006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27047,null,"See CPT",null,919.29759999999999,null,658.51240000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27048,null,"See CPT",null,1112.2072000000001,null,1112.2072000000001,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,754.37180000000001,null,754.37180000000001,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27052,null,"See CPT",null,1068.7429999999999,null,1068.7429999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27054,null,"See CPT",null,1267.6065999999998,null,1267.6065999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27057,null,"See CPT",null,1830.855,null,1830.855,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,862.7346,null,862.7346,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27062,null,"See CPT",null,841.89560000000006,null,841.89560000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27065,null,"See CPT",null,976.4559999999999,null,976.4559999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27066,null,"See CPT",null,1503.385,null,1503.385,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27067,null,"See CPT",null,1887.4179999999999,null,1887.4179999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27070,null,"See CPT",null,1627.8235999999999,null,1627.8235999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27071,null,"See CPT",null,1793.9402,null,1793.9402,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27075,null,"See CPT",null,3740.8981999999996,null,3740.8981999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27076,null,"See CPT",null,4514.3227999999999,null,4514.3227999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27077,null,"See CPT",null,5028.1530000000002,null,5028.1530000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27078,null,"See CPT",null,3688.5030000000002,null,3688.5030000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27080,null,"See CPT",null,935.37340000000006,null,935.37340000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27086,null,"See CPT",null,589.44600000000003,null,311.39420000000001,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27087,null,"See CPT",null,1119.9474,null,1119.9474,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27090,null,"See CPT",null,1520.0562,null,1520.0562,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27091,null,"See CPT",null,2873.4004,null,2873.4004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27093,null,"See CPT",null,445.95460000000003,null,122.05699999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27095,null,"See CPT",null,595.99540000000002,null,146.4684,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27096,null,"See CPT",null,304.24940000000004,null,148.85,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27097,null,"See CPT",null,1256.2940000000001,null,1256.2940000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27098,null,"See CPT",null,1278.9192,null,1278.9192,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27100,null,"See CPT",null,1521.8424,null,1521.8424,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27105,null,"See CPT",null,1592.6949999999999,null,1592.6949999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27110,null,"See CPT",null,1770.7195999999999,null,1770.7195999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27111,null,"See CPT",null,1650.4487999999999,null,1650.4487999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27120,null,"See CPT",null,2353.0208000000002,null,2353.0208000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27122,null,"See CPT",null,2002.9256,null,2002.9256,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27125,null,"See CPT",null,2052.3438000000001,null,2052.3438000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27130,null,"See CPT",null,2319.6784000000002,null,2319.6784000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27132,null,"See CPT",null,3011.5331999999999,null,3011.5331999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27134,null,"See CPT",null,3419.9775999999997,null,3419.9775999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27137,null,"See CPT",null,2639.4081999999999,null,2639.4081999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27138,null,"See CPT",null,2740.0308,null,2740.0308,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27140,null,"See CPT",null,1633.7776000000001,null,1633.7776000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27146,null,"See CPT",null,2297.0531999999998,null,2297.0531999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27147,null,"See CPT",null,2641.7898,null,2641.7898,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27151,null,"See CPT",null,2853.1568000000002,null,2853.1568000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27156,null,"See CPT",null,3071.0731999999998,null,3071.0731999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27158,null,"See CPT",null,2529.2592,null,2529.2592,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R"]
[27161,null,"See CPT",null,2212.5063999999998,null,2212.5063999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27165,null,"See CPT",null,2491.1536000000001,null,2491.1536000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27170,null,"See CPT",null,2120.8147999999997,null,2120.8147999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27175,null,"See CPT",null,1219.3792000000001,null,1219.3792000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[27176,null,"See CPT",null,1684.3865999999998,null,1684.3865999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27177,null,"See CPT",null,2028.5278000000001,null,2028.5278000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27178,null,"See CPT",null,1684.3865999999998,null,1684.3865999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27179,null,"See CPT",null,1783.8184000000001,null,1783.8184000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27181,null,"See CPT",null,2035.0771999999999,null,2035.0771999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27185,null,"See CPT",null,1319.4064000000001,null,1319.4064000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[27187,null,"See CPT",null,1814.7791999999999,null,1814.7791999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27197,null,"See CPT",null,247.09100000000001,null,247.09100000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[27198,null,"See CPT",null,572.77479999999991,null,572.77479999999991,null,"000",0,0,0,0,2,0,0,2,0,null,"R"]
[27200,null,"See CPT",null,353.07219999999995,null,356.64460000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[27202,null,"See CPT",null,967.52499999999998,null,967.52499999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[27215,null,"See CPT",null,1097.9176,null,1097.9176,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27216,null,"See CPT",null,1622.4649999999999,null,1622.4649999999999,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27217,null,"See CPT",null,1526.0101999999999,null,1526.0101999999999,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27218,null,"See CPT",null,2088.6632,null,2088.6632,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27220,null,"See CPT",null,774.02,null,761.51659999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27222,null,"See CPT",null,1795.1309999999999,null,1795.1309999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27226,null,"See CPT",null,1915.9972,null,1915.9972,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27227,null,"See CPT",null,2974.0230000000001,null,2974.0230000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27228,null,"See CPT",null,3377.1088,null,3377.1088,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27230,null,"See CPT",null,907.98500000000001,null,889.52760000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27232,null,"See CPT",null,1313.4523999999999,null,1313.4523999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27235,null,"See CPT",null,1651.0442,null,1651.0442,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27236,null,"See CPT",null,2162.4928,null,2162.4928,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27238,null,"See CPT",null,869.28399999999999,null,869.28399999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27240,null,"See CPT",null,1742.1404,null,1742.1404,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27244,null,"See CPT",null,2223.819,null,2223.819,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27245,null,"See CPT",null,2222.0328,null,2222.0328,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27246,null,"See CPT",null,728.17420000000004,null,719.83859999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27248,null,"See CPT",null,1358.1073999999999,null,1358.1073999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27250,null,"See CPT",null,316.1574,null,316.1574,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27252,null,"See CPT",null,1372.9923999999999,null,1372.9923999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27253,null,"See CPT",null,1712.3704,null,1712.3704,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27254,null,"See CPT",null,2303.0072,null,2303.0072,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27256,null,"See CPT",null,576.34719999999993,null,431.06959999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27257,null,"See CPT",null,654.93999999999994,null,654.93999999999994,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27258,null,"See CPT",null,2019.5968,null,2019.5968,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27259,null,"See CPT",null,2787.6628000000001,null,2787.6628000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27265,null,"See CPT",null,774.61540000000002,null,774.61540000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27266,null,"See CPT",null,1077.0786000000001,null,1077.0786000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27267,null,"See CPT",null,819.2704,null,819.2704,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27268,null,"See CPT",null,1005.6306000000001,null,1005.6306000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27269,null,"See CPT",null,2241.681,null,2241.681,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27275,null,"See CPT",null,338.7826,null,338.7826,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[27279,null,"See CPT",null,1474.2104000000002,null,1474.2104000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27280,null,"See CPT",null,2444.7123999999999,null,2444.7123999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27282,null,"See CPT",null,1573.6422,null,1573.6422,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27284,null,"See CPT",null,2884.7130000000002,null,2884.7130000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27286,null,"See CPT",null,2962.1149999999998,null,2962.1149999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27290,null,"See CPT",null,2934.1311999999998,null,2934.1311999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27295,null,"See CPT",null,2268.4740000000002,null,2268.4740000000002,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",null,"Y-UR"]
[27301,null,"See CPT",null,1253.9123999999999,null,931.80100000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27303,null,"See CPT",null,1169.9609999999998,null,1169.9609999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27305,null,"See CPT",null,896.077,null,896.077,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27306,null,"See CPT",null,622.19299999999998,null,622.19299999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27307,null,"See CPT",null,756.1579999999999,null,756.1579999999999,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27310,null,"See CPT",null,1345.0085999999999,null,1345.0085999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27323,null,"See CPT",null,513.83019999999999,null,321.51600000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27324,null,"See CPT",null,757.34879999999998,null,757.34879999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27325,null,"See CPT",null,1044.3316,null,1044.3316,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27326,null,"See CPT",null,968.71579999999994,null,968.71579999999994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27327,null,"See CPT",null,942.51819999999998,null,579.32420000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27328,null,"See CPT",null,1136.6186,null,1136.6186,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27329,null,"See CPT",null,1879.6777999999999,null,1879.6777999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27330,null,"See CPT",null,785.33259999999996,null,785.33259999999996,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27331,null,"See CPT",null,883.57359999999994,null,883.57359999999994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27332,null,"See CPT",null,1190.2045999999998,null,1190.2045999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27333,null,"See CPT",null,1089.5820000000001,null,1089.5820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27334,null,"See CPT",null,1264.0342000000001,null,1264.0342000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27335,null,"See CPT",null,1403.3578,null,1403.3578,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27337,null,"See CPT",null,763.89819999999997,null,763.89819999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27339,null,"See CPT",null,1365.2521999999999,null,1365.2521999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27340,null,"See CPT",null,698.99959999999999,null,698.99959999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27345,null,"See CPT",null,900.24479999999994,null,900.24479999999994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27347,null,"See CPT",null,976.4559999999999,null,976.4559999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27350,null,"See CPT",null,1206.2804000000001,null,1206.2804000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27355,null,"See CPT",null,1121.7336,null,1121.7336,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27356,null,"See CPT",null,1358.7028,null,1358.7028,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27357,null,"See CPT",null,1501.5988,null,1501.5988,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27358,null,"See CPT",null,487.63259999999997,null,487.63259999999997,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR"]
[27360,null,"See CPT",null,1665.3337999999999,null,1665.3337999999999,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,3686.7168000000001,null,3686.7168000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27369,null,"See CPT",null,355.4538,null,72.043399999999991,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27372,null,"See CPT",null,1103.2762,null,737.10520000000008,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27380,null,"See CPT",null,1158.6484,null,1158.6484,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27381,null,"See CPT",null,1511.1251999999999,null,1511.1251999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27385,null,"See CPT",null,1130.0691999999999,null,1130.0691999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27386,null,"See CPT",null,1576.6192000000001,null,1576.6192000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27390,null,"See CPT",null,835.94159999999999,null,835.94159999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27391,null,"See CPT",null,1071.72,null,1071.72,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[27392,null,"See CPT",null,1310.4754,null,1310.4754,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[27393,null,"See CPT",null,928.22860000000003,null,928.22860000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27394,null,"See CPT",null,1203.3034,null,1203.3034,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[27395,null,"See CPT",null,1613.5340000000001,null,1613.5340000000001,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[27396,null,"See CPT",null,1140.7864,null,1140.7864,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27397,null,"See CPT",null,1672.4785999999999,null,1672.4785999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27400,null,"See CPT",null,1279.5146,null,1279.5146,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27403,null,"See CPT",null,1186.6322,null,1186.6322,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27405,null,"See CPT",null,1243.1951999999999,null,1243.1951999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27407,null,"See CPT",null,1461.1116,null,1461.1116,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27409,null,"See CPT",null,1764.7655999999999,null,1764.7655999999999,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",null,"Y-UR"]
[27415,null,"See CPT",null,2489.3674000000001,null,2489.3674000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27416,null,"See CPT",null,1783.8184000000001,null,1783.8184000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[27418,null,"See CPT",null,1518.27,null,1518.27,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27420,null,"See CPT",null,1368.8245999999999,null,1368.8245999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27422,null,"See CPT",null,1361.0844,null,1361.0844,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27424,null,"See CPT",null,1374.1831999999999,null,1374.1831999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27425,null,"See CPT",null,844.87259999999992,null,844.87259999999992,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27427,null,"See CPT",null,1303.9259999999999,null,1303.9259999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27428,null,"See CPT",null,2037.4587999999999,null,2037.4587999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27429,null,"See CPT",null,2295.8624,null,2295.8624,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27430,null,"See CPT",null,1361.6798000000001,null,1361.6798000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27435,null,"See CPT",null,1487.3091999999999,null,1487.3091999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27437,null,"See CPT",null,1215.8068000000001,null,1215.8068000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27438,null,"See CPT",null,1535.5365999999999,null,1535.5365999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27440,null,"See CPT",null,1460.5162,null,1460.5162,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27441,null,"See CPT",null,1506.9574,null,1506.9574,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27442,null,"See CPT",null,1590.9087999999999,null,1590.9087999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27443,null,"See CPT",null,1492.6677999999999,null,1492.6677999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27445,null,"See CPT",null,2271.451,null,2271.451,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27446,null,"See CPT",null,2077.9459999999999,null,2077.9459999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27447,null,"See CPT",null,2317.2968000000001,null,2317.2968000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27448,null,"See CPT",null,1513.5068000000001,null,1513.5068000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27450,null,"See CPT",null,1849.3123999999998,null,1849.3123999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27454,null,"See CPT",null,2343.4944,null,2343.4944,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27455,null,"See CPT",null,1756.43,null,1756.43,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27457,null,"See CPT",null,1746.9035999999999,null,1746.9035999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27465,null,"See CPT",null,2260.1383999999998,null,2260.1383999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27466,null,"See CPT",null,2150.5847999999996,null,2150.5847999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27468,null,"See CPT",null,2427.4458,null,2427.4458,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27470,null,"See CPT",null,2143.44,null,2143.44,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27472,null,"See CPT",null,2293.4808000000003,null,2293.4808000000003,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",null,"Y-UR"]
[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",null,"Y-UR"]
[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",null,"Y-UR"]
[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",null,"Y-UR"]
[27486,null,"See CPT",null,2537.5947999999999,null,2537.5947999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27487,null,"See CPT",null,3156.8108000000002,null,3156.8108000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27488,null,"See CPT",null,2177.3778000000002,null,2177.3778000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27495,null,"See CPT",null,2052.3438000000001,null,2052.3438000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27496,null,"See CPT",null,1015.7524,null,1015.7524,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27497,null,"See CPT",null,1068.1476,null,1068.1476,null,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R"]
[27498,null,"See CPT",null,1210.4481999999998,null,1210.4481999999998,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27499,null,"See CPT",null,1290.8271999999999,null,1290.8271999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27500,null,"See CPT",null,975.86059999999998,null,891.90920000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27501,null,"See CPT",null,938.35039999999992,null,921.67920000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27502,null,"See CPT",null,1376.5648000000001,null,1376.5648000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27503,null,"See CPT",null,1466.4702,null,1466.4702,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27506,null,"See CPT",null,2426.2550000000001,null,2426.2550000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27507,null,"See CPT",null,1754.0484000000001,null,1754.0484000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27508,null,"See CPT",null,981.2192,null,927.03779999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27509,null,"See CPT",null,1254.5078000000001,null,1254.5078000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27510,null,"See CPT",null,1247.9584,null,1247.9584,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27511,null,"See CPT",null,1802.8712,null,1802.8712,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27513,null,"See CPT",null,2227.9868000000001,null,2227.9868000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27514,null,"See CPT",null,1748.6898000000001,null,1748.6898000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27516,null,"See CPT",null,974.07439999999997,null,907.98500000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27517,null,"See CPT",null,1271.7744,null,1271.7744,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27519,null,"See CPT",null,1615.9156,null,1615.9156,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27520,null,"See CPT",null,621.59759999999994,null,572.77479999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27524,null,"See CPT",null,1381.328,null,1381.328,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27530,null,"See CPT",null,589.44600000000003,null,551.93579999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27532,null,"See CPT",null,1153.8851999999999,null,1071.1245999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27535,null,"See CPT",null,1626.0373999999999,null,1626.0373999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27536,null,"See CPT",null,2153.5617999999999,null,2153.5617999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27538,null,"See CPT",null,912.7482,null,845.46799999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27540,null,"See CPT",null,1491.4770000000001,null,1491.4770000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27550,null,"See CPT",null,965.14340000000004,null,881.78740000000005,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27552,null,"See CPT",null,1169.9609999999998,null,1169.9609999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27556,null,"See CPT",null,1590.3134,null,1590.3134,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27557,null,"See CPT",null,1888.6088,null,1888.6088,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27558,null,"See CPT",null,2145.2262000000001,null,2145.2262000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27560,null,"See CPT",null,709.12139999999999,null,645.41359999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27562,null,"See CPT",null,912.7482,null,912.7482,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27566,null,"See CPT",null,1627.8235999999999,null,1627.8235999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27570,null,"See CPT",null,284.00579999999997,null,284.00579999999997,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27580,null,"See CPT",null,2680.4908,null,2680.4908,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27590,null,"See CPT",null,1389.0681999999999,null,1389.0681999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27591,null,"See CPT",null,1755.8345999999999,null,1755.8345999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27592,null,"See CPT",null,1194.3724,null,1194.3724,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27594,null,"See CPT",null,907.98500000000001,null,907.98500000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27596,null,"See CPT",null,1277.7284,null,1277.7284,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27598,null,"See CPT",null,1243.7906,null,1243.7906,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,728.17420000000004,null,728.17420000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27601,null,"See CPT",null,807.95780000000002,null,807.95780000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27602,null,"See CPT",null,851.42200000000003,null,851.42200000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27603,null,"See CPT",null,985.38700000000006,null,718.05240000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27604,null,"See CPT",null,838.32320000000004,null,590.63679999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27605,null,"See CPT",null,616.83439999999996,null,334.6148,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27606,null,"See CPT",null,492.99119999999994,null,492.99119999999994,null,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R"]
[27607,null,"See CPT",null,1093.7498000000001,null,1093.7498000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27610,null,"See CPT",null,1182.4643999999998,null,1182.4643999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27612,null,"See CPT",null,1039.5684000000001,null,1039.5684000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27613,null,"See CPT",null,471.55680000000001,null,294.12760000000003,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27614,null,"See CPT",null,1097.9176,null,763.30280000000005,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,915.12979999999993,null,562.65299999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27619,null,"See CPT",null,855.58979999999997,null,855.58979999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27620,null,"See CPT",null,818.07960000000003,null,818.07960000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27625,null,"See CPT",null,1047.904,null,1047.904,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27626,null,"See CPT",null,1116.375,null,1116.375,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27630,null,"See CPT",null,1000.8673999999999,null,653.74919999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27632,null,"See CPT",null,746.63159999999993,null,746.63159999999993,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27634,null,"See CPT",null,1229.501,null,1229.501,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27635,null,"See CPT",null,1064.5752,null,1064.5752,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27637,null,"See CPT",null,1356.9166,null,1356.9166,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27638,null,"See CPT",null,1365.8476000000001,null,1365.8476000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27640,null,"See CPT",null,1516.4838,null,1516.4838,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27641,null,"See CPT",null,1191.3954000000001,null,1191.3954000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27645,null,"See CPT",null,3182.413,null,3182.413,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27646,null,"See CPT",null,2770.3962000000001,null,2770.3962000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27647,null,"See CPT",null,1785.0092,null,1785.0092,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27648,null,"See CPT",null,409.6352,null,91.096199999999996,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[27650,null,"See CPT",null,1209.2574,null,1209.2574,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27652,null,"See CPT",null,1208.662,null,1208.662,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27654,null,"See CPT",null,1308.6892,null,1308.6892,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27656,null,"See CPT",null,1007.4168000000001,null,638.86419999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27658,null,"See CPT",null,680.54219999999998,null,680.54219999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27659,null,"See CPT",null,862.13919999999996,null,862.13919999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27664,null,"See CPT",null,671.61119999999994,null,671.61119999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[27665,null,"See CPT",null,776.40159999999992,null,776.40159999999992,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27675,null,"See CPT",null,912.7482,null,912.7482,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27676,null,"See CPT",null,1111.0164,null,1111.0164,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27680,null,"See CPT",null,769.2568,null,769.2568,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[27681,null,"See CPT",null,928.22860000000003,null,928.22860000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27685,null,"See CPT",null,1222.9515999999999,null,855.58979999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27686,null,"See CPT",null,965.73879999999997,null,965.73879999999997,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27687,null,"See CPT",null,834.15539999999999,null,834.15539999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27690,null,"See CPT",null,1170.5563999999999,null,1170.5563999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27691,null,"See CPT",null,1362.2751999999998,null,1362.2751999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27692,null,"See CPT",null,178.02460000000002,null,178.02460000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[27695,null,"See CPT",null,891.31380000000001,null,891.31380000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27696,null,"See CPT",null,1003.249,null,1003.249,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27698,null,"See CPT",null,1169.9609999999998,null,1169.9609999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27700,null,"See CPT",null,1116.375,null,1116.375,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27702,null,"See CPT",null,1747.499,null,1747.499,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27703,null,"See CPT",null,2016.6197999999997,null,2016.6197999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27704,null,"See CPT",null,1043.1407999999999,null,1043.1407999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27705,null,"See CPT",null,1377.7556,null,1377.7556,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27707,null,"See CPT",null,753.18100000000004,null,753.18100000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27709,null,"See CPT",null,2055.9162000000001,null,2055.9162000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27712,null,"See CPT",null,2003.521,null,2003.521,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27715,null,"See CPT",null,1949.3396,null,1949.3396,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27720,null,"See CPT",null,1595.0765999999999,null,1595.0765999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27722,null,"See CPT",null,1635.5637999999999,null,1635.5637999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27724,null,"See CPT",null,2266.0924,null,2266.0924,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27725,null,"See CPT",null,2209.5293999999999,null,2209.5293999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27726,null,"See CPT",null,1740.3542,null,1740.3542,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,1084.8188,null,1084.8188,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[27732,null,"See CPT",null,843.68179999999995,null,843.68179999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[27734,null,"See CPT",null,1210.4481999999998,null,1210.4481999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[27740,null,"See CPT",null,1300.3535999999999,null,1300.3535999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27742,null,"See CPT",null,1424.7921999999999,null,1424.7921999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27745,null,"See CPT",null,1382.5187999999998,null,1382.5187999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27750,null,"See CPT",null,661.48939999999993,null,612.07119999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27752,null,"See CPT",null,1003.8444,null,913.34359999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27756,null,"See CPT",null,1066.3614,null,1066.3614,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27758,null,"See CPT",null,1636.7546,null,1636.7546,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27759,null,"See CPT",null,1813.5884000000001,null,1813.5884000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27760,null,"See CPT",null,632.91020000000003,null,581.70579999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27762,null,"See CPT",null,910.36659999999995,null,817.48419999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27766,null,"See CPT",null,1119.9474,null,1119.9474,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27767,null,"See CPT",null,556.69899999999996,null,554.31740000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27768,null,"See CPT",null,838.91859999999997,null,838.91859999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27769,null,"See CPT",null,1331.3144,null,1331.3144,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27780,null,"See CPT",null,591.23219999999992,null,542.40940000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27781,null,"See CPT",null,828.79679999999996,null,759.13499999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27784,null,"See CPT",null,1304.5214000000001,null,1304.5214000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27786,null,"See CPT",null,598.37700000000007,null,545.38639999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27788,null,"See CPT",null,804.3854,null,723.41100000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27792,null,"See CPT",null,1186.6322,null,1186.6322,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27808,null,"See CPT",null,640.05499999999995,null,581.70579999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27810,null,"See CPT",null,893.69539999999995,null,799.62220000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27814,null,"See CPT",null,1401.5716,null,1401.5716,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27816,null,"See CPT",null,629.93319999999994,null,556.69899999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27818,null,"See CPT",null,925.25159999999994,null,820.46119999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27822,null,"See CPT",null,1611.1523999999999,null,1611.1523999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27823,null,"See CPT",null,1807.039,null,1807.039,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27824,null,"See CPT",null,603.14020000000005,null,578.72879999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27825,null,"See CPT",null,1018.134,null,912.15279999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27826,null,"See CPT",null,1574.2376000000002,null,1574.2376000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27827,null,"See CPT",null,2056.5115999999998,null,2056.5115999999998,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27828,null,"See CPT",null,2425.6596,null,2425.6596,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27829,null,"See CPT",null,1308.0937999999999,null,1308.0937999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27830,null,"See CPT",null,738.89139999999998,null,679.35140000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27831,null,"See CPT",null,765.68439999999998,null,765.68439999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27832,null,"See CPT",null,1390.8543999999999,null,1390.8543999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27840,null,"See CPT",null,723.41100000000006,null,723.41100000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27842,null,"See CPT",null,909.77119999999991,null,909.77119999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27846,null,"See CPT",null,1316.4294,null,1316.4294,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27848,null,"See CPT",null,1433.1278,null,1433.1278,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27860,null,"See CPT",null,301.27239999999995,null,301.27239999999995,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27870,null,"See CPT",null,1835.0228,null,1835.0228,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27871,null,"See CPT",null,1267.6065999999998,null,1267.6065999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27880,null,"See CPT",null,1595.672,null,1595.672,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27881,null,"See CPT",null,1526.6056000000001,null,1526.6056000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27882,null,"See CPT",null,1050.8809999999999,null,1050.8809999999999,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR"]
[27884,null,"See CPT",null,1038.973,null,1038.973,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27886,null,"See CPT",null,1162.2208000000001,null,1162.2208000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27888,null,"See CPT",null,1155.6713999999999,null,1155.6713999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27889,null,"See CPT",null,1131.8554000000001,null,1131.8554000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27892,null,"See CPT",null,972.8836,null,972.8836,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27893,null,"See CPT",null,1132.4508000000001,null,1132.4508000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27894,null,"See CPT",null,1469.4472000000001,null,1469.4472000000001,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,317.34820000000002,null,172.07060000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28002,null,"See CPT",null,456.67179999999996,null,251.25879999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28003,null,"See CPT",null,697.80880000000002,null,464.41199999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28005,null,"See CPT",null,1040.1637999999998,null,1040.1637999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28008,null,"See CPT",null,793.66819999999996,null,538.83699999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28010,null,"See CPT",null,431.06959999999998,null,381.65140000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28011,null,"See CPT",null,578.13340000000005,null,509.66240000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28020,null,"See CPT",null,1018.7293999999999,null,676.37439999999992,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28022,null,"See CPT",null,902.03100000000006,null,598.97239999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28024,null,"See CPT",null,851.42200000000003,null,561.46219999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28035,null,"See CPT",null,981.81459999999993,null,657.32159999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28039,null,"See CPT",null,890.12299999999993,null,621.59759999999994,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28041,null,"See CPT",null,820.46119999999996,null,820.46119999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28043,null,"See CPT",null,712.09840000000008,null,476.91539999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28045,null,"See CPT",null,889.52760000000001,null,635.29179999999997,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,768.66139999999996,null,509.06700000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28052,null,"See CPT",null,719.83859999999993,null,465.6028,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28054,null,"See CPT",null,679.35140000000001,null,427.49719999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28055,null,"See CPT",null,700.19039999999995,null,700.19039999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28060,null,"See CPT",null,957.40319999999986,null,657.32159999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28062,null,"See CPT",null,1063.3843999999999,null,735.9144,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28070,null,"See CPT",null,938.94579999999996,null,627.55159999999989,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28072,null,"See CPT",null,908.58039999999994,null,594.80460000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28080,null,"See CPT",null,990.15019999999993,null,696.02260000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28086,null,"See CPT",null,988.36400000000003,null,649.58140000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28088,null,"See CPT",null,856.18520000000001,null,535.86,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28090,null,"See CPT",null,863.33,null,565.03459999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28092,null,"See CPT",null,783.54639999999995,null,498.34979999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28100,null,"See CPT",null,1139.0001999999999,null,767.47059999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28102,null,"See CPT",null,1126.4968000000001,null,1126.4968000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28103,null,"See CPT",null,703.76279999999997,null,703.76279999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28104,null,"See CPT",null,969.90659999999991,null,646.00900000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28106,null,"See CPT",null,772.23379999999997,null,772.23379999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28107,null,"See CPT",null,932.39639999999997,null,630.52859999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[28108,null,"See CPT",null,804.98079999999993,null,527.52440000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28110,null,"See CPT",null,853.20820000000003,null,534.66920000000005,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28111,null,"See CPT",null,881.78740000000005,null,582.30119999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28112,null,"See CPT",null,895.48159999999996,null,573.96559999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28113,null,"See CPT",null,1083.0326,null,781.76020000000005,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28114,null,"See CPT",null,1967.2015999999999,null,1530.7734,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28116,null,"See CPT",null,1440.2726,null,1076.4831999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28118,null,"See CPT",null,1115.1841999999999,null,769.2568,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28119,null,"See CPT",null,969.3112000000001,null,664.46640000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28120,null,"See CPT",null,1240.8136,null,907.38959999999997,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28122,null,"See CPT",null,1090.1773999999998,null,799.62220000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28124,null,"See CPT",null,880.00119999999993,null,610.28499999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28126,null,"See CPT",null,724.00639999999999,null,454.88559999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28130,null,"See CPT",null,1106.2531999999999,null,1106.2531999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28140,null,"See CPT",null,1046.7131999999999,null,773.42460000000005,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28150,null,"See CPT",null,774.61540000000002,null,509.66240000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28153,null,"See CPT",null,752.5856,null,483.46479999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28160,null,"See CPT",null,757.34879999999998,null,487.63259999999997,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,450.12239999999997,null,241.13699999999997,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[28192,null,"See CPT",null,848.44499999999994,null,566.22540000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28193,null,"See CPT",null,962.76180000000011,null,667.4434,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28200,null,"See CPT",null,917.51139999999998,null,599.56780000000003,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28202,null,"See CPT",null,1106.8486,null,784.14179999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[28208,null,"See CPT",null,905.00799999999992,null,591.82759999999996,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28210,null,"See CPT",null,1101.49,null,777.5924,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[28220,null,"See CPT",null,832.96460000000002,null,557.2944,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28222,null,"See CPT",null,974.66980000000001,null,664.46640000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28225,null,"See CPT",null,768.06600000000003,null,484.06020000000007,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28226,null,"See CPT",null,1157.4576,null,739.48680000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28230,null,"See CPT",null,803.79,null,521.57039999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28232,null,"See CPT",null,700.78579999999999,null,440.596,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28234,null,"See CPT",null,761.51659999999993,null,494.18200000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28238,null,"See CPT",null,1243.1951999999999,null,894.88619999999992,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28240,null,"See CPT",null,821.65200000000004,null,536.45539999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28250,null,"See CPT",null,1086.605,null,750.79939999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28260,null,"See CPT",null,1326.5512000000001,null,972.28819999999985,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28261,null,"See CPT",null,2216.6741999999999,null,1709.9887999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28262,null,"See CPT",null,2563.7924000000003,null,2041.6265999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28264,null,"See CPT",null,1612.9386,null,1227.1194,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28270,null,"See CPT",null,900.24479999999994,null,611.47579999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28272,null,"See CPT",null,707.93060000000003,null,457.86260000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28280,null,"See CPT",null,943.70899999999995,null,635.29179999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28285,null,"See CPT",null,994.91340000000002,null,704.95359999999994,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28286,null,"See CPT",null,814.50720000000001,null,540.6232,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28288,null,"See CPT",null,1118.1612,null,797.24059999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28289,null,"See CPT",null,1275.9422,null,841.89560000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28291,null,"See CPT",null,1286.6594,null,882.97820000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28292,null,"See CPT",null,1286.6594,null,882.38279999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28295,null,"See CPT",null,2001.1394,null,1116.375,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28296,null,"See CPT",null,1646.8763999999999,null,933.58719999999994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28297,null,"See CPT",null,1913.6156000000001,null,1098.5129999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28298,null,"See CPT",null,1547.4445999999998,null,921.0838,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28299,null,"See CPT",null,1874.9145999999998,null,1077.674,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28300,null,"See CPT",null,1187.8229999999999,null,1187.8229999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28302,null,"See CPT",null,1314.0478000000001,null,1314.0478000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28304,null,"See CPT",null,1531.9641999999999,null,1120.5427999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28305,null,"See CPT",null,1220.57,null,1220.57,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28306,null,"See CPT",null,1127.6876,null,741.27299999999991,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28307,null,"See CPT",null,1466.4702,null,953.83079999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28308,null,"See CPT",null,1057.4304000000002,null,707.93060000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28309,null,"See CPT",null,1634.9684,null,1634.9684,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28310,null,"See CPT",null,1005.6306000000001,null,659.70320000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28312,null,"See CPT",null,993.12720000000002,null,620.40679999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28313,null,"See CPT",null,980.02840000000003,null,660.29859999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28315,null,"See CPT",null,887.7414,null,597.78159999999991,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28320,null,"See CPT",null,1116.375,null,1116.375,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28322,null,"See CPT",null,1456.3484000000001,null,1057.4304000000002,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,469.17519999999996,null,434.642,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28405,null,"See CPT",null,849.63580000000002,null,759.13499999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28406,null,"See CPT",null,1049.0948000000001,null,1049.0948000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28415,null,"See CPT",null,2056.5115999999998,null,2056.5115999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28420,null,"See CPT",null,2372.6689999999999,null,2372.6689999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28430,null,"See CPT",null,455.48099999999999,null,397.72719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28435,null,"See CPT",null,700.78579999999999,null,617.4298,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28436,null,"See CPT",null,931.80100000000004,null,931.80100000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28445,null,"See CPT",null,1890.9904000000001,null,1890.9904000000001,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,398.91800000000001,null,359.6216,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28455,null,"See CPT",null,551.34039999999993,null,489.41880000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28456,null,"See CPT",null,704.35820000000001,null,704.35820000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28465,null,"See CPT",null,1168.1748,null,1168.1748,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28470,null,"See CPT",null,413.20760000000001,null,387.01,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28475,null,"See CPT",null,484.65560000000005,null,423.9248,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28476,null,"See CPT",null,732.34199999999998,null,732.34199999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28485,null,"See CPT",null,1037.7821999999999,null,1037.7821999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28490,null,"See CPT",null,269.12079999999997,null,236.37380000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28495,null,"See CPT",null,336.99639999999999,null,279.24260000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28496,null,"See CPT",null,859.75759999999991,null,464.41199999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28505,null,"See CPT",null,1205.0895999999998,null,906.19880000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28510,null,"See CPT",null,228.6336,null,227.44279999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28515,null,"See CPT",null,309.608,null,269.12079999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28525,null,"See CPT",null,1054.4534000000001,null,746.03620000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28530,null,"See CPT",null,218.51179999999999,null,188.74179999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28531,null,"See CPT",null,615.04819999999995,null,332.82859999999999,null,"090",0.1,0.69,0.21,0,2,1,1,2,0,null,"R"]
[28540,null,"See CPT",null,366.17099999999999,null,328.06540000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28545,null,"See CPT",null,588.25520000000006,null,512.63939999999991,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28546,null,"See CPT",null,1111.0164,null,659.70320000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28555,null,"See CPT",null,1604.0076000000001,null,1215.2113999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28570,null,"See CPT",null,448.9316,null,373.31579999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28575,null,"See CPT",null,716.86159999999995,null,639.45960000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28576,null,"See CPT",null,718.64779999999996,null,718.64779999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28585,null,"See CPT",null,1630.2051999999999,null,1272.9651999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28600,null,"See CPT",null,413.803,null,350.09519999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28605,null,"See CPT",null,650.17679999999996,null,576.94259999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28606,null,"See CPT",null,711.50299999999993,null,711.50299999999993,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28615,null,"See CPT",null,1523.0331999999999,null,1523.0331999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28630,null,"See CPT",null,286.9828,null,201.84059999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28635,null,"See CPT",null,328.06540000000001,null,246.49559999999997,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28636,null,"See CPT",null,581.70579999999995,null,364.38479999999998,null,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R"]
[28645,null,"See CPT",null,1198.5401999999999,null,885.35979999999995,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28660,null,"See CPT",null,232.8014,null,170.87980000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[28665,null,"See CPT",null,275.67019999999997,null,228.6336,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28666,null,"See CPT",null,324.49299999999999,null,324.49299999999999,null,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R"]
[28675,null,"See CPT",null,1071.1245999999999,null,759.13499999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28705,null,"See CPT",null,2206.5524,null,2206.5524,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28715,null,"See CPT",null,1716.5382,null,1716.5382,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28725,null,"See CPT",null,1420.6243999999999,null,1420.6243999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28730,null,"See CPT",null,1330.7190000000001,null,1330.7190000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28735,null,"See CPT",null,1419.4336000000001,null,1419.4336000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28737,null,"See CPT",null,1248.5537999999999,null,1248.5537999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28740,null,"See CPT",null,1527.7963999999999,null,1127.0922,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28750,null,"See CPT",null,1445.6312,null,1055.0488,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28755,null,"See CPT",null,935.96879999999999,null,612.07119999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28760,null,"See CPT",null,1400.3807999999999,null,1029.4466,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28800,null,"See CPT",null,957.40319999999986,null,957.40319999999986,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28805,null,"See CPT",null,1271.7744,null,1271.7744,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28810,null,"See CPT",null,765.08899999999994,null,765.08899999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28820,null,"See CPT",null,549.55420000000004,null,317.9436,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28825,null,"See CPT",null,538.83699999999999,null,308.41719999999998,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,662.08479999999997,null,356.04920000000004,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29010,null,"See CPT",null,515.02099999999996,null,291.74600000000004,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29015,null,"See CPT",null,551.34039999999993,null,327.46999999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29035,null,"See CPT",null,484.65560000000005,null,261.38059999999996,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29040,null,"See CPT",null,551.93579999999997,null,314.37119999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29044,null,"See CPT",null,541.81399999999996,null,304.84480000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29046,null,"See CPT",null,592.423,null,341.75960000000003,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29049,null,"See CPT",null,185.76480000000001,null,126.2248,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29055,null,"See CPT",null,419.16160000000002,null,250.06800000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29058,null,"See CPT",null,229.22900000000001,null,169.68899999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29065,null,"See CPT",null,181.0016,null,124.43859999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29075,null,"See CPT",null,164.3304,null,114.9122,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29085,null,"See CPT",null,179.8108,null,122.6524,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29086,null,"See CPT",null,144.08679999999998,null,90.500799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29105,null,"See CPT",null,154.20859999999999,null,75.020399999999995,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29125,null,"See CPT",null,124.43859999999999,null,73.829599999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29126,null,"See CPT",null,145.27760000000001,null,89.9054,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29130,null,"See CPT",null,77.402000000000001,null,52.990600000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29131,null,"See CPT",null,99.431799999999996,null,63.112400000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29200,null,"See CPT",null,60.135399999999997,null,33.342400000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29240,null,"See CPT",null,55.967599999999997,null,32.747,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29260,null,"See CPT",null,54.181400000000004,null,34.533199999999994,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29280,null,"See CPT",null,54.776800000000001,null,35.723999999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29305,null,"See CPT",null,464.41199999999998,null,288.17359999999996,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29325,null,"See CPT",null,512.04399999999998,null,322.1114,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29345,null,"See CPT",null,251.85420000000002,null,180.40619999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29355,null,"See CPT",null,263.76220000000001,null,192.3142,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29358,null,"See CPT",null,300.08159999999998,null,186.36019999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29365,null,"See CPT",null,231.01519999999999,null,158.37640000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29405,null,"See CPT",null,148.85,null,106.5766,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29425,null,"See CPT",null,139.3236,null,98.241,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29435,null,"See CPT",null,213.74859999999998,null,146.4684,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29440,null,"See CPT",null,78.592799999999997,null,50.013599999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29445,null,"See CPT",null,235.18300000000002,null,176.8338,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",null,"Y-CM"]
[29505,null,"See CPT",null,166.11660000000001,null,94.668599999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29515,null,"See CPT",null,133.36960000000002,null,89.31,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29520,null,"See CPT",null,64.898600000000002,null,32.747,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29530,null,"See CPT",null,55.372199999999999,null,32.747,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29540,null,"See CPT",null,51.799799999999998,null,30.960799999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29550,null,"See CPT",null,35.128599999999999,null,19.648199999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29580,null,"See CPT",null,117.8892,null,46.441200000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29581,null,"See CPT",null,169.09359999999998,null,48.227400000000003,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29584,null,"See CPT",null,155.9948,null,28.5792,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29700,null,"See CPT",null,116.10299999999999,null,58.944600000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29705,null,"See CPT",null,115.5076,null,80.379000000000005,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29710,null,"See CPT",null,225.6566,null,147.06380000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29720,null,"See CPT",null,160.75800000000001,null,78.592799999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29740,null,"See CPT",null,181.59699999999998,null,123.24779999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29822,null,"See CPT",null,997.29499999999996,null,997.29499999999996,null,"090",0.1,0.69,0.21,0,3,1,2,0,0,29805,"R",null,"Y-UR"]
[29838,null,"See CPT",null,1094.3452,null,1094.3452,null,"090",0.1,0.69,0.21,0,3,1,0,0,0,29830,"R",null,"Y-UR"]
[29848,null,"See CPT",null,947.8768,null,947.8768,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[29870,null,"See CPT",null,1027.0650000000001,null,751.39479999999992,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[29874,null,"See CPT",null,985.38700000000006,null,985.38700000000006,null,"090",0.1,0.69,0.21,0,3,1,0,0,0,29870,"R",null,"Y-UR"]
[29882,null,"See CPT",null,1262.248,null,1262.248,null,"090",0.1,0.69,0.21,0,3,1,1,0,0,29870,"R",null,"Y-UR"]
[29895,null,"See CPT",null,847.84960000000001,null,847.84960000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[29904,null,"See CPT",null,1172.9379999999999,null,1172.9379999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[30110,null,"See CPT",null,472.74760000000003,null,244.70940000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[30210,null,"See CPT",null,285.19659999999999,null,191.71880000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[30420,null,"See CPT",null,2715.6194,null,2715.6194,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[30560,null,"See CPT",null,622.19299999999998,null,283.41039999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[30620,null,"See CPT",null,1278.9192,null,1278.9192,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[30906,null,"See CPT",null,707.93060000000003,null,238.75539999999998,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[31051,null,"See CPT",null,1306.3076000000001,null,1306.3076000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,1,1,0,0,null,"R"]
[31086,null,"See CPT",null,2196.4306000000001,null,2196.4306000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,0,0,null,"R"]
[31235,null,"See CPT",null,585.27819999999997,null,287.57819999999998,null,"000",0,0,0,0,3,1,0,0,0,31231,"R"]
[31276,null,"See CPT",null,678.16060000000004,null,678.16060000000004,null,"000",0,0,0,0,3,1,1,0,0,31231,"R"]
[31294,null,"See CPT",null,2232.75,null,2232.75,null,"010",0.1,0.8,0.1,0,3,1,0,0,0,31231,"R"]
[31375,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"]
[31500,null,"See CPT",null,248.2818,null,248.2818,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[31510,null,"See CPT",null,405.4674,null,219.70259999999999,null,"000",0,0,0,0,3,0,0,0,0,31505,"R"]
[31531,null,"See CPT",null,381.05600000000004,null,381.05600000000004,null,"000",0,0,0,0,3,0,0,0,0,31526,"R"]
[31551,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,1,0,null,"X"]
[31574,null,"See CPT",null,1827.8779999999999,null,269.71620000000001,null,"000",0,0,0,0,3,1,0,0,0,31575,"R",null,"Y-CM"]
[31600,null,"See CPT",null,541.21860000000004,null,541.21860000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[31613,null,"See CPT",null,790.69119999999998,null,790.69119999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[31631,null,"See CPT",null,398.32260000000002,null,398.32260000000002,null,"000",0,0,0,0,3,0,1,0,0,31622,"R"]
[31638,null,"See CPT",null,435.23739999999998,null,435.23739999999998,null,"000",0,0,0,0,3,0,1,0,0,31622,"R"]
[31643,null,"See CPT",null,298.89079999999996,null,298.89079999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[31717,null,"See CPT",null,540.6232,null,188.1464,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[31766,null,"See CPT",null,3094.8891999999996,null,3094.8891999999996,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[31899,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[32120,null,"See CPT",null,1538.5136,null,1538.5136,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[32225,null,"See CPT",null,1754.6437999999998,null,1754.6437999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[32488,null,"See CPT",null,4160.0598,null,4160.0598,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[32507,null,"See CPT",null,269.71620000000001,null,269.71620000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[32551,null,"See CPT",null,272.69319999999999,null,272.69319999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[32606,null,"See CPT",null,800.81299999999999,null,800.81299999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[32653,null,"See CPT",null,1858.2434000000001,null,1858.2434000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[32667,null,"See CPT",null,269.71620000000001,null,269.71620000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[32701,null,"See CPT",null,366.76639999999998,null,366.76639999999998,null,"000",0,0,0,2,0,0,0,1,0,null,"R"]
[32855,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"]
[33017,null,"See CPT",null,426.90179999999998,null,426.90179999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33050,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"]
[33140,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X"]
[33215,null,"See CPT",null,550.745,null,550.745,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33223,null,"See CPT",null,729.96039999999994,null,729.96039999999994,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[33236,null,"See CPT",null,1384.9004,null,1384.9004,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,1617.7018,null,1617.7018,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[33263,null,"See CPT",null,688.87779999999998,null,688.87779999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33285,null,"See CPT",null,8360.6067999999996,null,154.20859999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[33320,null,"See CPT",null,1871.3422,null,1871.3422,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,2483.4133999999999,null,2483.4133999999999,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,3942.1433999999995,null,3942.1433999999995,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,5806.3407999999999,null,5806.3407999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33426,null,"See CPT",null,4136.8392000000003,null,4136.8392000000003,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33465,null,"See CPT",null,4774.5126,null,4774.5126,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,2241.0855999999999,null,2241.0855999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33514,null,"See CPT",null,4520.2767999999996,null,4520.2767999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33523,null,"See CPT",null,1422.4105999999999,null,1422.4105999999999,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[33534,null,"See CPT",null,3820.0863999999997,null,3820.0863999999997,null,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33619,null,"See CPT",null,4782.8481999999995,null,4782.8481999999995,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33622,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"]
[33688,null,"See CPT",null,3259.8150000000001,null,3259.8150000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33720,null,"See CPT",null,2701.3298,null,2701.3298,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33755,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"]
[33775,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X"]
[33786,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"]
[33802,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"]
[33866,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,1,null,"X",null,"Y-CM"]
[33877,null,"See CPT",null,6205.2587999999996,null,6205.2587999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[33901,null,"See CPT",null,1337.8637999999999,null,1337.8637999999999,null,"000",0,0,0,0,2,2,0,0,0,null,"R",null,"Y-UR"]
[33917,null,"See CPT",null,2551.8843999999999,null,2551.8843999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33940,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
[33953,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[33964,null,"See CPT",null,847.84960000000001,null,847.84960000000001,null,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM"]
[33967,null,"See CPT",null,445.95460000000003,null,445.95460000000003,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[33984,null,"See CPT",null,488.82340000000005,null,488.82340000000005,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[33987,null,"See CPT",null,356.64460000000003,null,356.64460000000003,null,"000",0,0,0,0,0,0,0,1,1,null,"R",null,"Y-CM"]
[34101,null,"See CPT",null,1034.2098000000001,null,1034.2098000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[34451,null,"See CPT",null,2457.2157999999999,null,2457.2157999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[34705,null,"See CPT",null,2621.5462000000002,null,2621.5462000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[34712,null,"See CPT",null,1134.8324,null,1134.8324,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[34831,null,"See CPT",null,3297.9205999999999,null,3297.9205999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[34833,null,"See CPT",null,666.25259999999992,null,666.25259999999992,null,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-CM"]
[35021,null,"See CPT",null,2200.5983999999999,null,2200.5983999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35081,null,"See CPT",null,2968.6644000000001,null,2968.6644000000001,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,1879.6777999999999,null,1879.6777999999999,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,2289.9083999999998,null,2289.9083999999998,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,2503.0616,null,2503.0616,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[35276,null,"See CPT",null,2543.5488,null,2543.5488,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[35341,null,"See CPT",null,2378.0275999999999,null,2378.0275999999999,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,1765.3609999999999,null,1765.3609999999999,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,2086.2815999999998,null,2086.2815999999998,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,2001.1394,null,2001.1394,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35565,null,"See CPT",null,2250.6119999999996,null,2250.6119999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35571,null,"See CPT",null,2270.2602000000002,null,2270.2602000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35626,null,"See CPT",null,2755.5111999999999,null,2755.5111999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35638,null,"See CPT",null,2977,null,2977,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35671,null,"See CPT",null,1961.8430000000001,null,1961.8430000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35697,null,"See CPT",null,250.06800000000001,null,250.06800000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-CM"]
[35860,null,"See CPT",null,1458.73,null,1458.73,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35876,null,"See CPT",null,1623.0604000000001,null,1623.0604000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[36014,null,"See CPT",null,1499.2172,null,263.76220000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36140,null,"See CPT",null,971.69280000000003,null,154.20859999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36226,null,"See CPT",null,3768.8819999999996,null,634.101,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36251,null,"See CPT",null,2453.0480000000002,null,444.7638,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36415,null,"See CPT",null,12.1694,null,12.1694,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[36465,null,"See CPT",null,2517.9465999999998,null,206.60380000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[36476,null,"See CPT",null,526.33359999999993,null,231.61060000000001,null,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM"]
[36481,null,"See CPT",null,3330.0722000000001,null,572.17939999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36561,null,"See CPT",null,1864.7927999999999,null,590.63679999999999,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[36566,null,"See CPT",null,8197.467200000001,null,632.91020000000003,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[36582,null,"See CPT",null,1668.9062000000001,null,509.66240000000005,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[36592,null,"See CPT",null,55.372199999999999,null,55.372199999999999,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[36800,null,"See CPT",null,213.1532,null,213.1532,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36823,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"X"]
[36833,null,"See CPT",null,1399.7854,null,1399.7854,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[36903,null,"See CPT",null,8237.3590000000004,null,546.57719999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[37186,null,"See CPT",null,2255.9706000000001,null,417.9708,null,"000",0,0,0,0,0,2,1,2,0,null,"R"]
[37191,null,"See CPT",null,3909.9918000000002,null,386.41460000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[37217,null,"See CPT",null,1864.1973999999998,null,1864.1973999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,0,0,0,null,"R"]
[37225,null,"See CPT",null,16876.612999999998,null,1026.4695999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[37237,null,"See CPT",null,2466.1468,null,359.6216,null,"000",0,0,0,0,0,1,0,0,0,null,"R"]
[37246,null,"See CPT",null,3463.4418000000001,null,600.7586,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[37253,null,"See CPT",null,318.53899999999999,null,122.05699999999999,null,"000",0,0,0,0,0,0,0,1,0,null,"R"]
[37615,null,"See CPT",null,928.22860000000003,null,928.22860000000003,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[37785,null,"See CPT",null,639.45960000000002,null,451.31319999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[37799,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[38200,null,"See CPT",null,231.61060000000001,null,231.61060000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[38215,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[38308,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"]
[38520,null,"See CPT",null,847.84960000000001,null,847.84960000000001,null,"090",0.11,0.73,0.16,0,2,1,1,0,0,null,"R"]
[38573,null,"See CPT",null,2109.5021999999999,null,2109.5021999999999,null,"010",0.1,0.8,0.1,0,3,2,2,2,0,49320,"R",null,"Y-UR"]
[38720,null,"See CPT",null,2423.8733999999999,null,2423.8733999999999,null,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[39000,null,"See CPT",null,863.33,null,863.33,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[39220,null,"See CPT",null,2001.7347999999997,null,2001.7347999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[39541,null,"See CPT",null,1655.212,null,1655.212,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[40650,null,"See CPT",null,903.81719999999996,null,579.32420000000002,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R"]
[40805,null,"See CPT",null,531.69219999999996,null,362.00319999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[40818,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"]
[41005,null,"See CPT",null,456.07639999999998,null,222.67960000000002,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[41008,null,"See CPT",null,735.31899999999996,null,472.15219999999999,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R"]
[41115,null,"See CPT",null,497.15899999999999,null,270.90699999999998,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[41130,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"]
[41250,null,"See CPT",null,537.64619999999991,null,281.62420000000003,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[41821,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[41899,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[42140,null,"See CPT",null,594.80460000000005,null,302.46319999999997,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[42227,null,"See CPT",null,1568.2836,null,1568.2836,null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[42305,null,"See CPT",null,776.99700000000007,null,776.99700000000007,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R"]
[42400,null,"See CPT",null,182.78779999999998,null,96.454800000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[42426,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"]
[42510,null,"See CPT",null,1122.3290000000002,null,1122.3290000000002,null,"090",0.09,0.81,0.1,0,2,2,2,1,0,null,"R"]
[42806,null,"See CPT",null,456.67179999999996,null,262.57139999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[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"]
[42892,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"]
[42975,null,"See CPT",null,173.85679999999999,null,173.85679999999999,null,"000",0,0,0,0,3,0,1,0,0,31575,"R",null,"Y-CM"]
[43107,null,"See CPT",null,5218.6810000000005,null,5218.6810000000005,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43118,null,"See CPT",null,6288.6148000000003,null,6288.6148000000003,null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[43191,null,"See CPT",null,281.02879999999999,null,281.02879999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[43198,null,"See CPT",null,399.51339999999999,null,176.23839999999998,null,"000",0,0,0,0,3,0,1,0,0,43197,"R",null,"Y-CM"]
[43215,null,"See CPT",null,744.84539999999993,null,250.6634,null,"000",0,0,0,0,3,0,1,0,0,43200,"R"]
[43231,null,"See CPT",null,281.02879999999999,null,281.02879999999999,null,"000",0,0,0,0,3,0,1,2,0,43200,"R"]
[43244,null,"See CPT",null,435.23739999999998,null,435.23739999999998,null,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,"Y-CM"]
[43257,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,43235,"X"]
[43265,null,"See CPT",null,766.27979999999991,null,766.27979999999991,null,"000",0,0,0,0,3,0,1,0,0,43260,"R",null,"Y-CM"]
[43282,null,"See CPT",null,3060.9513999999999,null,3060.9513999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43286,null,"See CPT",null,5591.4013999999997,null,5591.4013999999997,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[43291,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,43235,"X"]
[43331,null,"See CPT",null,2353.6161999999999,null,2353.6161999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43338,null,"See CPT",null,198.26820000000001,null,198.26820000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[43425,null,"See CPT",null,2530.4499999999998,null,2530.4499999999998,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43605,null,"See CPT",null,1487.3091999999999,null,1487.3091999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43632,null,"See CPT",null,3605.1469999999999,null,3605.1469999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43653,null,"See CPT",null,1044.3316,null,1044.3316,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43754,null,"See CPT",null,454.29019999999997,null,68.470999999999989,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[43762,null,"See CPT",null,434.642,null,64.898600000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[43830,null,"See CPT",null,1265.2249999999999,null,1265.2249999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[43846,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"]
[43999,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[44120,null,"See CPT",null,2169.6376,null,2169.6376,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44132,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[44147,null,"See CPT",null,3417.596,null,3417.596,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44160,null,"See CPT",null,2210.1247999999996,null,2210.1247999999996,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44204,null,"See CPT",null,2727.5273999999999,null,2727.5273999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44212,null,"See CPT",null,3610.5056,null,3610.5056,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44314,null,"See CPT",null,1798.7034000000001,null,1798.7034000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44366,null,"See CPT",null,426.3064,null,426.3064,null,"000",0,0,0,0,3,0,1,0,0,44360,"R"]
[44384,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,44380,"X"]
[44392,null,"See CPT",null,723.41100000000006,null,353.07219999999995,null,"000",0,0,0,0,3,0,1,0,0,44388,"R",null,"Y-CM"]
[44603,null,"See CPT",null,2866.2556,null,2866.2556,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44640,null,"See CPT",null,2475.0778,null,2475.0778,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44705,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[44850,null,"See CPT",null,1336.673,null,1336.673,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44979,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,2,1,1,null,"X"]
[45119,null,"See CPT",null,3361.6284000000001,null,3361.6284000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45136,null,"See CPT",null,3201.4657999999999,null,3201.4657999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45315,null,"See CPT",null,428.0926,null,188.1464,null,"000",0,0,0,0,3,0,1,0,0,45300,"R",null,"Y-CM"]
[45338,null,"See CPT",null,565.03459999999995,null,214.34399999999999,null,"000",0,0,0,0,3,0,1,0,0,45330,"R",null,"Y-CM"]
[45350,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,45330,"X"]
[45379,null,"See CPT",null,811.53020000000004,null,423.32940000000002,null,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM"]
[45397,null,"See CPT",null,3790.3163999999997,null,3790.3163999999997,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45402,null,"See CPT",null,2700.7343999999998,null,2700.7343999999998,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45805,null,"See CPT",null,2623.3324000000002,null,2623.3324000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45990,null,"See CPT",null,187.55099999999999,null,187.55099999999999,null,"000",0,0,0,0,2,0,0,1,1,null,"R"]
[46220,null,"See CPT",null,475.12920000000003,null,222.08420000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[46280,null,"See CPT",null,883.57359999999994,null,883.57359999999994,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46601,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,46600,"X"]
[46607,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,46600,"X"]
[46716,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"]
[46916,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"]
[46945,null,"See CPT",null,629.33780000000002,null,629.33780000000002,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[47125,null,"See CPT",null,5443.1468000000004,null,5443.1468000000004,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[47300,null,"See CPT",null,2034.4818,null,2034.4818,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[47379,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[47382,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"]
[47538,null,"See CPT",null,7305.558,null,411.42140000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[47552,null,"See CPT",null,485.84640000000002,null,485.84640000000002,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[47563,null,"See CPT",null,1289.0409999999999,null,1289.0409999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[47612,null,"See CPT",null,2266.6878000000002,null,2266.6878000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[47765,null,"See CPT",null,5241.9016000000001,null,5241.9016000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48102,null,"See CPT",null,968.71579999999994,null,417.9708,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[48150,null,"See CPT",null,5525.3119999999999,null,5525.3119999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48154,null,"See CPT",null,5141.2789999999995,null,5141.2789999999995,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"]
[49060,null,"See CPT",null,1951.7212,null,1951.7212,null,"090",0.09,0.81,0.1,0,2,0,1,1,0,null,"R"]
[49185,null,"See CPT",null,2450.0709999999999,null,210.17619999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[49320,null,"See CPT",null,591.23219999999992,null,591.23219999999992,null,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[49406,null,"See CPT",null,1699.867,null,342.35500000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[49427,null,"See CPT",null,68.470999999999989,null,68.470999999999989,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[49442,null,"See CPT",null,1524.2240000000002,null,368.55260000000004,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[49451,null,"See CPT",null,1231.8826000000001,null,155.39939999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[49550,null,"See CPT",null,1040.1637999999998,null,1040.1637999999998,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[49557,null,"See CPT",null,1297.972,null,1297.972,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[49616,null,"See CPT",null,1517.6745999999998,null,1517.6745999999998,null,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[49621,null,"See CPT",null,1315.2385999999999,null,1315.2385999999999,null,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[50020,null,"See CPT",null,1812.3976,null,1812.3976,null,"090",0.08,0.83,0.09,0,2,0,1,1,0,null,"R"]
[50080,null,"See CPT",null,1244.9813999999999,null,1244.9813999999999,null,"090",0.08,0.83,0.09,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[50234,null,"See CPT",null,2314.3197999999998,null,2314.3197999999998,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[50250,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"X"]
[50384,null,"See CPT",null,1640.9223999999999,null,398.91800000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[50387,null,"See CPT",null,1070.5291999999999,null,145.87300000000002,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[50500,null,"See CPT",null,2227.9868000000001,null,2227.9868000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[50526,null,"See CPT",null,2803.1432,null,2803.1432,null,"090",0.08,0.83,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[50553,null,"See CPT",null,700.78579999999999,null,554.31740000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[50574,null,"See CPT",null,991.34099999999989,null,991.34099999999989,null,"000",0,0,0,0,3,1,0,0,0,50570,"R"]
[50630,null,"See CPT",null,1589.7179999999998,null,1589.7179999999998,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50684,null,"See CPT",null,240.54159999999999,null,91.691599999999994,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[50750,null,"See CPT",null,2048.7713999999996,null,2048.7713999999996,null,"090",0.08,0.83,0.09,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[50780,null,"See CPT",null,1975.5372,null,1975.5372,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50940,null,"See CPT",null,1585.5501999999999,null,1585.5501999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[50945,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"]
[50980,null,"See CPT",null,626.36079999999993,null,626.36079999999993,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[51065,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,0,0,0,0,null,"X"]
[51565,null,"See CPT",null,2291.0991999999997,null,2291.0991999999997,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[51580,null,"See CPT",null,3359.8422,null,3359.8422,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,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"]
[51725,26,"See CPT",null,135.1558,null,135.1558,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51741,null,"See CPT",null,25.6022,null,25.6022,null,"000",0,0,0,1,2,0,1,0,0,null,"R"]
[51741,26,"See CPT",null,14.885,null,14.885,null,"000",0,0,0,1,2,0,1,0,0,null,"R"]
[51797,26,"See CPT",null,70.852599999999995,null,70.852599999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[51860,null,"See CPT",null,1337.8637999999999,null,1337.8637999999999,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[52000,null,"See CPT",null,453.69479999999999,null,142.3006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[52007,null,"See CPT",null,852.61279999999999,null,292.93680000000001,null,"000",0,0,0,0,3,1,1,0,0,52000,"R",null,"Y-CM"]
[52282,null,"See CPT",null,591.82759999999996,null,591.82759999999996,null,"000",0,0,0,0,3,0,1,0,0,52000,"R"]
[52287,null,"See CPT",null,729.36500000000001,null,298.89079999999996,null,"000",0,0,0,0,3,0,1,0,0,52000,"R"]
[52342,null,"See CPT",null,544.79100000000005,null,544.79100000000005,null,"000",0,0,0,0,3,1,1,0,0,52000,"R"]
[52345,null,"See CPT",null,692.4502,null,692.4502,null,"000",0,0,0,0,3,1,0,0,0,52351,"R"]
[52400,null,"See CPT",null,849.63580000000002,null,849.63580000000002,null,"090",0.08,0.83,0.09,0,3,0,1,0,0,52000,"R",null,"Y-CM"]
[52648,null,"See CPT",null,3032.3721999999998,null,1239.6228000000001,null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[53210,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"X"]
[53260,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"]
[53440,null,"See CPT",null,1346.7948000000001,null,1346.7948000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53445,null,"See CPT",null,1357.5119999999999,null,1357.5119999999999,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53520,null,"See CPT",null,1005.0351999999999,null,1005.0351999999999,null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[53605,null,"See CPT",null,113.12599999999999,null,113.12599999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[53854,null,"See CPT",null,3191.9393999999998,null,688.87779999999998,null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[54057,null,"See CPT",null,266.73920000000004,null,179.21539999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[54135,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.8,0.1,0,2,2,2,0,0,null,"X",null,"Y-CM"]
[54200,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"]
[54300,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"]
[54312,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"]
[54390,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"]
[54405,null,"See CPT",null,1444.4404000000002,null,1444.4404000000002,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[54417,null,"See CPT",null,1606.3892000000001,null,1606.3892000000001,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[54520,null,"See CPT",null,591.82759999999996,null,591.82759999999996,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[54680,null,"See CPT",null,1408.1209999999999,null,1408.1209999999999,null,"090",0.1,0.8,0.1,0,2,1,2,1,0,null,"R"]
[54840,null,"See CPT",null,582.30119999999999,null,582.30119999999999,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[55120,null,"See CPT",null,641.84119999999996,null,641.84119999999996,null,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[55180,null,"See CPT",null,1237.8365999999999,null,1237.8365999999999,null,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[55700,null,"See CPT",null,447.74079999999998,null,229.8244,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[55720,null,"See CPT",null,812.12560000000008,null,812.12560000000008,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[55831,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"]
[55874,null,"See CPT",null,5571.1578,null,292.93680000000001,null,"000",0,0,0,0,2,0,1,1,1,null,"R",null,"Y-CM"]
[56442,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[56630,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[56820,null,"See CPT",null,231.61060000000001,null,151.827,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[57010,null,"See CPT",null,838.91859999999997,null,838.91859999999997,null,"090",0.12,0.74,0.14000000000000001,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[57150,null,"See CPT",null,108.95820000000001,null,45.845799999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[57160,null,"See CPT",null,138.13279999999997,null,82.165199999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[57240,null,"See CPT",null,1115.7795999999998,null,1115.7795999999998,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57287,null,"See CPT",null,1357.5119999999999,null,1357.5119999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57307,null,"See CPT",null,1972.5602000000001,null,1972.5602000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57415,null,"See CPT",null,322.1114,null,322.1114,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[57465,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[57522,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.12,0.74,0.14000000000000001,0,2,0,1,0,0,null,"X"]
[58100,null,"See CPT",null,188.1464,null,112.53059999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[58140,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[58210,null,"See CPT",null,3283.6309999999999,null,3283.6309999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[58292,null,"See CPT",null,2364.9287999999997,null,2364.9287999999997,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58346,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.12,0.74,0.14000000000000001,0,2,0,1,0,0,null,"X"]
[58542,null,"See CPT",null,1505.7665999999999,null,1505.7665999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58559,null,"See CPT",null,507.28079999999994,null,507.28079999999994,null,"000",0,0,0,0,3,0,1,2,0,58555,"R",null,"Y-CM"]
[58571,null,"See CPT",null,1644.4947999999999,null,1644.4947999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58662,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,3,0,2,2,0,49320,"X"]
[58672,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.8,0.1,0,3,1,2,0,0,49320,"X"]
[58750,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"]
[58940,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"]
[58974,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,2,1,0,null,"X"]
[59020,null,"See CPT",null,129.7972,null,129.7972,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[59074,null,"See CPT",null,690.66399999999999,null,543.60020000000009,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[59140,null,"See CPT",null,755.56259999999997,null,755.56259999999997,null,"090",0.17,0.6,0.23,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[59412,null,"See CPT",null,181.59699999999998,null,181.59699999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[59426,null,"See CPT",null,1857.0526,null,1406.3348000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[59612,null,"See CPT",null,1594.4811999999999,null,1594.4811999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59851,null,"See CPT",null,776.99700000000007,null,776.99700000000007,null,"090",0.17,0.6,0.23,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59871,null,"See CPT",null,235.7784,null,235.7784,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[60252,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"]
[60605,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"]
[61107,null,"See CPT",null,546.57719999999995,null,546.57719999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[61140,null,"See CPT",null,2278.5958000000001,null,2278.5958000000001,null,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R"]
[61250,null,"See CPT",null,1565.3065999999999,null,1565.3065999999999,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R"]
[61323,null,"See CPT",null,4244.0111999999999,null,4244.0111999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[61458,null,"See CPT",null,3592.6436000000003,null,3592.6436000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,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"]
[61537,null,"See CPT",null,4353.5648000000001,null,4353.5648000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61546,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"]
[61570,null,"See CPT",null,3339.5986000000003,null,3339.5986000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[61583,null,"See CPT",null,5277.6256000000003,null,5277.6256000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61586,null,"See CPT",null,4623.8764000000001,null,4623.8764000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61607,null,"See CPT",null,4798.3285999999998,null,4798.3285999999998,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61619,null,"See CPT",null,2571.5326,null,2571.5326,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R"]
[61680,null,"See CPT",null,3979.6536000000001,null,3979.6536000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61703,null,"See CPT",null,2436.9722000000002,null,2436.9722000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61737,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,1,0,0,0,null,"X"]
[61798,null,"See CPT",null,2461.9790000000003,null,2461.9790000000003,null,"090",0.11,0.76,0.13,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[61867,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"]
[61885,null,"See CPT",null,962.16639999999995,null,962.16639999999995,null,"090",0.11,0.76,0.13,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[62141,null,"See CPT",null,2051.1530000000002,null,2051.1530000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[62160,null,"See CPT",null,328.66079999999999,null,328.66079999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[62223,null,"See CPT",null,1868.9606000000001,null,1868.9606000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[62269,null,"See CPT",null,465.6028,null,465.6028,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[62287,null,"See CPT",null,1027.0650000000001,null,1027.0650000000001,null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[62321,null,"See CPT",null,492.99119999999994,null,191.1234,null,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR"]
[62328,null,"See CPT",null,435.83280000000002,null,153.61320000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[62351,null,"See CPT",null,1635.5637999999999,null,1635.5637999999999,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[63003,null,"See CPT",null,2211.3155999999999,null,2211.3155999999999,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[63020,null,"See CPT",null,1980.8958000000002,null,1980.8958000000002,null,"090",0.11,0.76,0.13,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[63051,null,"See CPT",null,3035.3491999999997,null,3035.3491999999997,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[63066,null,"See CPT",null,359.02620000000002,null,359.02620000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[63101,null,"See CPT",null,4146.9610000000002,null,4146.9610000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63200,null,"See CPT",null,2736.4584,null,2736.4584,null,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[63268,null,"See CPT",null,2516.7558000000004,null,2516.7558000000004,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63272,null,"See CPT",null,3340.7894000000001,null,3340.7894000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63287,null,"See CPT",null,4867.9904000000006,null,4867.9904000000006,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63304,null,"See CPT",null,4182.6849999999995,null,4182.6849999999995,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63662,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",null,"Y-UR"]
[63704,null,"See CPT",null,2997.8389999999999,null,2997.8389999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64415,null,"See CPT",null,250.6634,null,123.8432,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[64447,null,"See CPT",null,216.1302,null,112.53059999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[64461,null,"See CPT",null,249.47260000000003,null,138.72820000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[64479,null,"See CPT",null,496.56360000000001,null,234.58759999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[64517,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[64553,null,"See CPT",null,4837.625,null,712.09840000000008,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[64584,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.11,0.76,0.13,0,2,1,0,1,1,null,"X"]
[64611,null,"See CPT",null,239.35079999999996,null,203.03140000000002,null,"010",0.1,0.8,0.1,0,2,2,0,0,0,null,"R",null,"Y-CM"]
[64633,null,"See CPT",null,822.84280000000001,null,344.73660000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[64650,null,"See CPT",null,166.11660000000001,null,72.638800000000003,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[64712,null,"See CPT",null,1087.7957999999999,null,1087.7957999999999,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[64716,null,"See CPT",null,940.13659999999993,null,940.13659999999993,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64760,null,"See CPT",null,942.51819999999998,null,942.51819999999998,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64771,null,"See CPT",null,1060.4073999999998,null,1060.4073999999998,null,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[64792,null,"See CPT",null,1918.9741999999999,null,1918.9741999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64821,null,"See CPT",null,1275.3468,null,1275.3468,null,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[64858,null,"See CPT",null,2122.0056,null,2122.0056,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R"]
[64886,null,"See CPT",null,2341.1127999999999,null,2341.1127999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[64890,null,"See CPT",null,1951.1258000000003,null,1951.1258000000003,null,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R"]
[64901,null,"See CPT",null,1050.2855999999999,null,1050.2855999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[65114,null,"See CPT",null,2904.3611999999998,null,2904.3611999999998,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65135,null,"See CPT",null,1610.557,null,1610.557,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[65270,null,"See CPT",null,537.05079999999998,null,257.21280000000002,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[65290,null,"See CPT",null,891.31380000000001,null,891.31380000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[65750,null,"See CPT",null,2295.2669999999998,null,2295.2669999999998,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65770,null,"See CPT",null,2552.4797999999996,null,2552.4797999999996,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[65815,null,"See CPT",null,1193.777,null,868.09320000000002,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[65860,null,"See CPT",null,565.03459999999995,null,449.52699999999999,null,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R"]
[66170,null,"See CPT",null,1992.2084,null,1992.2084,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[66175,null,"See CPT",null,1319.4064000000001,null,1319.4064000000001,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[66625,null,"See CPT",null,782.95100000000002,null,782.95100000000002,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66711,null,"See CPT",null,927.63319999999999,null,927.63319999999999,null,"090",0.1,0.7,0.2,0,3,1,1,0,0,66710,"R"]
[66852,null,"See CPT",null,1522.4377999999999,null,1522.4377999999999,null,"090",0.1,0.7,0.2,0,2,1,0,1,0,null,"R"]
[66985,null,"See CPT",null,1399.7854,null,1399.7854,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[67027,null,"See CPT",null,1536.7274,null,1536.7274,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[67036,null,"See CPT",null,1625.442,null,1625.442,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67121,null,"See CPT",null,1637.9454000000001,null,1637.9454000000001,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67208,null,"See CPT",null,1099.7038,null,1047.3086000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[67311,null,"See CPT",null,828.79679999999996,null,828.79679999999996,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[67332,null,"See CPT",null,376.88819999999998,null,376.88819999999998,null,"000",0,0,0,0,0,1,1,1,0,null,"R",null,"Y-CM"]
[67414,null,"See CPT",null,2676.9184,null,2676.9184,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67500,null,"See CPT",null,139.3236,null,114.3168,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[67805,null,"See CPT",null,375.10199999999998,null,297.7,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[67820,null,"See CPT",null,35.128599999999999,null,39.891800000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[67902,null,"See CPT",null,1318.8109999999999,null,1318.8109999999999,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[67912,null,"See CPT",null,1702.2485999999999,null,884.76439999999991,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[67973,null,"See CPT",null,1672.4785999999999,null,1672.4785999999999,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67999,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[68328,null,"See CPT",null,1279.5146,null,1279.5146,null,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R"]
[68399,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[68700,null,"See CPT",null,1094.3452,null,1094.3452,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[68745,null,"See CPT",null,1496.2402,null,1496.2402,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[68841,null,"See CPT",null,69.661799999999999,null,58.944600000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69100,null,"See CPT",null,181.0016,null,84.54679999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[69320,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"]
[69421,null,"See CPT",null,282.815,null,282.815,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69540,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"]
[69604,null,"See CPT",null,2067.2287999999999,null,2067.2287999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69644,null,"See CPT",null,2814.4558000000002,null,2814.4558000000002,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69666,null,"See CPT",null,1505.7665999999999,null,1505.7665999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R"]
[69719,null,"See CPT",null,1179.4874,null,1179.4874,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69728,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"X"]
[69949,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[69960,null,"See CPT",null,3443.1981999999998,null,3443.1981999999998,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[70100,"TC","See CPT",null,57.753799999999998,null,57.753799999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70120,26,"See CPT",null,16.075800000000001,null,16.075800000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[70150,26,"See CPT",null,22.6252,null,22.6252,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70190,null,"See CPT",null,71.447999999999993,null,71.447999999999993,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[70240,null,"See CPT",null,62.517000000000003,null,62.517000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70250,26,"See CPT",null,16.075800000000001,null,16.075800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70328,null,"See CPT",null,65.494,null,65.494,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70330,null,"See CPT",null,100.62259999999999,null,100.62259999999999,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[70355,null,"See CPT",null,33.342400000000005,null,33.342400000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70370,"TC","See CPT",null,167.90279999999998,null,167.90279999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70450,"TC","See CPT",null,133.965,null,133.965,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70470,26,"See CPT",null,109.5536,null,109.5536,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70486,26,"See CPT",null,73.829599999999999,null,73.829599999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70487,26,"See CPT",null,97.05019999999999,null,97.05019999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70492,26,"See CPT",null,138.72820000000002,null,138.72820000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70498,26,"See CPT",null,150.63619999999997,null,150.63619999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70543,null,"See CPT",null,669.82500000000005,null,669.82500000000005,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70547,null,"See CPT",null,425.71100000000001,null,425.71100000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70552,null,"See CPT",null,533.47840000000008,null,533.47840000000008,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70554,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,4,3,0,0,0,null,"X"]
[70559,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[71045,"TC","See CPT",null,33.342400000000005,null,33.342400000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71100,"TC","See CPT",null,50.608999999999995,null,50.608999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71110,"TC","See CPT",null,58.349199999999996,null,58.349199999999996,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[71120,26,"See CPT",null,17.266599999999997,null,17.266599999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71270,26,"See CPT",null,107.172,null,107.172,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71551,26,"See CPT",null,148.85,null,148.85,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72020,null,"See CPT",null,46.441200000000002,null,46.441200000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72070,null,"See CPT",null,62.517000000000003,null,62.517000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72072,null,"See CPT",null,74.424999999999997,null,74.424999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72083,"TC","See CPT",null,119.08,null,119.08,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72100,"TC","See CPT",null,56.562999999999995,null,56.562999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72110,"TC","See CPT",null,75.020399999999995,null,75.020399999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72126,"TC","See CPT",null,225.6566,null,225.6566,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72130,"TC","See CPT",null,282.21960000000001,null,282.21960000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72132,26,"See CPT",null,104.79040000000001,null,104.79040000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72146,26,"See CPT",null,127.41560000000001,null,127.41560000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72149,null,"See CPT",null,534.07380000000001,null,534.07380000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72159,null,"See CPT",null,685.9008,null,685.9008,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72190,null,"See CPT",null,80.379000000000005,null,80.379000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72191,null,"See CPT",null,600.7586,null,600.7586,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72195,null,"See CPT",null,453.0994,null,453.0994,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72200,null,"See CPT",null,62.517000000000003,null,62.517000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72220,"TC","See CPT",null,46.441200000000002,null,46.441200000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72270,"TC","See CPT",null,191.1234,null,191.1234,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72295,26,"See CPT",null,72.043399999999991,null,72.043399999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[73030,26,"See CPT",null,16.671200000000002,null,16.671200000000002,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73040,26,"See CPT",null,48.822799999999994,null,48.822799999999994,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73085,null,"See CPT",null,212.55779999999999,null,212.55779999999999,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73090,26,"See CPT",null,13.6942,null,13.6942,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73110,null,"See CPT",null,77.997399999999999,null,77.997399999999999,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73140,null,"See CPT",null,72.043399999999991,null,72.043399999999991,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73206,null,"See CPT",null,585.27819999999997,null,585.27819999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[73219,"TC","See CPT",null,521.57039999999995,null,521.57039999999995,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73223,"TC","See CPT",null,584.68280000000004,null,584.68280000000004,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73225,"TC","See CPT",null,529.90600000000006,null,529.90600000000006,null,"000",0,0,0,1,4,0,9,0,0,null,"R"]
[73521,26,"See CPT",null,19.648199999999999,null,19.648199999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73523,"TC","See CPT",null,90.500799999999998,null,90.500799999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73551,26,"See CPT",null,14.885,null,14.885,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73564,26,"See CPT",null,20.243600000000001,null,20.243600000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73592,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[73615,null,"See CPT",null,247.09100000000001,null,247.09100000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73660,null,"See CPT",null,55.372199999999999,null,55.372199999999999,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73700,null,"See CPT",null,252.4496,null,252.4496,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73702,"TC","See CPT",null,279.24260000000004,null,279.24260000000004,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73721,26,"See CPT",null,116.69839999999999,null,116.69839999999999,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73722,"TC","See CPT",null,483.46479999999997,null,483.46479999999997,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[74019,"TC","See CPT",null,50.013599999999997,null,50.013599999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74160,"TC","See CPT",null,353.66759999999999,null,353.66759999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74174,26,"See CPT",null,187.55099999999999,null,187.55099999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74178,26,"See CPT",null,172.07060000000001,null,172.07060000000001,null,"000",0,0,0,1,4,0,9,0,0,null,"R"]
[74183,null,"See CPT",null,669.82500000000005,null,669.82500000000005,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74185,null,"See CPT",null,666.84799999999996,null,666.84799999999996,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74230,"TC","See CPT",null,196.482,null,196.482,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"]
[74250,null,"See CPT",null,234.58759999999998,null,234.58759999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74263,null,"See CPT",null,1309.2846,null,1309.2846,null,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM"]
[74280,"TC","See CPT",null,317.34820000000002,null,317.34820000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74301,"TC","See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74329,26,"See CPT",null,42.273399999999995,null,42.273399999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74330,26,"See CPT",null,50.013599999999997,null,50.013599999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74363,26,"See CPT",null,75.020399999999995,null,75.020399999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74410,26,"See CPT",null,41.677999999999997,null,41.677999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74430,26,"See CPT",null,27.388400000000001,null,27.388400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74450,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74710,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[74742,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[75557,"TC","See CPT",null,347.1182,null,347.1182,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75559,"TC","See CPT",null,487.63259999999997,null,487.63259999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75571,"TC","See CPT",null,144.68219999999999,null,144.68219999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75574,null,"See CPT",null,625.16999999999996,null,625.16999999999996,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75630,"TC","See CPT",null,123.8432,null,123.8432,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75710,null,"See CPT",null,278.05180000000001,null,278.05180000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75733,null,"See CPT",null,318.53899999999999,null,318.53899999999999,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[75746,null,"See CPT",null,253.04499999999999,null,253.04499999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75774,"TC","See CPT",null,98.836399999999998,null,98.836399999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75801,"TC","See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75809,"TC","See CPT",null,114.3168,null,114.3168,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75820,26,"See CPT",null,88.119199999999992,null,88.119199999999992,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75827,26,"See CPT",null,95.26400000000001,null,95.26400000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75840,26,"See CPT",null,98.241,null,98.241,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75872,26,"See CPT",null,98.241,null,98.241,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75889,26,"See CPT",null,92.287000000000006,null,92.287000000000006,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75894,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75898,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75958,"TC","See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75959,"TC","See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75989,"TC","See CPT",null,111.33980000000001,null,111.33980000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76080,"TC","See CPT",null,67.875599999999991,null,67.875599999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76125,"TC","See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76380,26,"See CPT",null,81.569800000000001,null,81.569800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76496,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76497,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76511,26,"See CPT",null,64.898600000000002,null,64.898600000000002,null,"000",0,0,0,1,7,3,0,0,0,null,"R"]
[76512,26,"See CPT",null,55.372199999999999,null,55.372199999999999,null,"000",0,0,0,1,7,3,0,0,0,null,"R"]
[76519,"TC","See CPT",null,71.447999999999993,null,71.447999999999993,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[76536,26,"See CPT",null,49.418199999999999,null,49.418199999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76700,"TC","See CPT",null,151.827,null,151.827,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76775,"TC","See CPT",null,60.730800000000002,null,60.730800000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76800,26,"See CPT",null,107.76739999999999,null,107.76739999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76801,26,"See CPT",null,85.142199999999988,null,85.142199999999988,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76813,null,"See CPT",null,220.298,null,220.298,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76814,null,"See CPT",null,139.3236,null,139.3236,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76818,null,"See CPT",null,219.70259999999999,null,219.70259999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[76820,26,"See CPT",null,42.8688,null,42.8688,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76827,null,"See CPT",null,131.58339999999998,null,131.58339999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76830,"TC","See CPT",null,167.90279999999998,null,167.90279999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76870,"TC","See CPT",null,136.3466,null,136.3466,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76872,"TC","See CPT",null,325.68379999999996,null,325.68379999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76886,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76932,"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"]
[76941,"TC","See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76945,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76975,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76978,26,"See CPT",null,139.3236,null,139.3236,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[76983,26,"See CPT",null,44.655000000000001,null,44.655000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76998,26,"See CPT",null,107.76739999999999,null,107.76739999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77012,null,"See CPT",null,264.35760000000005,null,264.35760000000005,null,"000",0,0,0,1,0,0,9,0,0,null,"R"]
[77013,null,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[77047,"TC","See CPT",null,294.72300000000001,null,294.72300000000001,null,"000",0,0,0,1,4,2,0,0,0,null,"R",null,"Y-UR"]
[77048,"TC","See CPT",null,485.25100000000003,null,485.25100000000003,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[77054,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77063,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,2,9,0,0,null,"X"]
[77072,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77073,null,"See CPT",null,85.142199999999988,null,85.142199999999988,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77078,"TC","See CPT",null,179.8108,null,179.8108,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77080,"TC","See CPT",null,54.776800000000001,null,54.776800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77091,null,"See CPT",null,53.585999999999999,null,53.585999999999999,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[77262,null,"See CPT",null,195.88659999999999,null,195.88659999999999,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[77293,"TC","See CPT",null,592.423,null,592.423,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77300,null,"See CPT",null,123.24779999999998,null,123.24779999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77307,26,"See CPT",null,277.45640000000003,null,277.45640000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77316,"TC","See CPT",null,327.46999999999997,null,327.46999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77332,26,"See CPT",null,43.464199999999998,null,43.464199999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77333,26,"See CPT",null,72.043399999999991,null,72.043399999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77399,26,"See CPT",null,"By Report ",null,"By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[77402,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"]
[77470,null,"See CPT",null,256.61739999999998,null,256.61739999999998,null,"000",0,0,0,1,0,0,0,0,0,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"]
[77610,26,"See CPT",null,125.03400000000001,null,125.03400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77750,null,"See CPT",null,726.98340000000007,null,726.98340000000007,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77767,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77768,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77789,"TC","See CPT",null,137.53739999999999,null,137.53739999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77790,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
[78014,"TC","See CPT",null,382.24680000000001,null,382.24680000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78016,26,"See CPT",null,58.944600000000001,null,58.944600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78071,"TC","See CPT",null,520.37959999999998,null,520.37959999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78075,26,"See CPT",null,63.707800000000006,null,63.707800000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78104,26,"See CPT",null,66.68480000000001,null,66.68480000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78110,26,"See CPT",null,13.6942,null,13.6942,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78140,null,"See CPT",null,206.00839999999999,null,206.00839999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78185,null,"See CPT",null,301.86779999999999,null,301.86779999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78201,null,"See CPT",null,341.16419999999999,null,341.16419999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78215,"TC","See CPT",null,310.20339999999999,null,310.20339999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78230,null,"See CPT",null,316.75280000000004,null,316.75280000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78232,"TC","See CPT",null,158.9718,null,158.9718,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78264,"TC","See CPT",null,520.37959999999998,null,520.37959999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78265,"TC","See CPT",null,612.6665999999999,null,612.6665999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78291,null,"See CPT",null,467.38899999999995,null,467.38899999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78299,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"]
[78305,"TC","See CPT",null,419.75700000000001,null,419.75700000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78399,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"]
[78430,null,"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,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR"]
[78451,null,"See CPT",null,599.56780000000003,null,599.56780000000003,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78452,null,"See CPT",null,832.96460000000002,null,832.96460000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78458,"TC","See CPT",null,293.53219999999999,null,293.53219999999999,null,"000",0,0,0,1,6,2,0,0,0,null,"R",null,"Y-CM"]
[78459,"TC","See CPT",null,3147.5847171225605,null,3147.5847171225605,null,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR"]
[78468,26,"See CPT",null,66.68480000000001,null,66.68480000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78481,26,"See CPT",null,82.760599999999997,null,82.760599999999997,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78494,26,"See CPT",null,100.02719999999999,null,100.02719999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78579,26,"See CPT",null,41.677999999999997,null,41.677999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78597,26,"See CPT",null,61.3262,null,61.3262,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78600,null,"See CPT",null,324.49299999999999,null,324.49299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78608,"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"]
[78630,"TC","See CPT",null,541.81399999999996,null,541.81399999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78660,"TC","See CPT",null,235.7784,null,235.7784,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78707,"TC","See CPT",null,335.21019999999999,null,335.21019999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78709,26,"See CPT",null,117.8892,null,117.8892,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78761,26,"See CPT",null,61.3262,null,61.3262,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78800,26,"See CPT",null,54.776800000000001,null,54.776800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78804,26,"See CPT",null,83.951399999999992,null,83.951399999999992,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78811,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78813,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78830,26,"See CPT",null,121.4616,null,121.4616,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78999,"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"]
[79200,"TC","See CPT",null,101.21799999999999,null,101.21799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[79445,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"]
[80047,null,"See CPT",null,19.496600000000001,null,19.496600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80145,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80155,null,"See CPT",null,54.769399999999997,null,54.769399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80163,null,"See CPT",null,18.857599999999998,null,18.857599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80178,null,"See CPT",null,9.3862000000000005,null,9.3862000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80186,null,"See CPT",null,19.539199999999997,null,19.539199999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80200,null,"See CPT",null,22.904599999999999,null,22.904599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80305,null,"See CPT",null,17.891999999999999,null,17.891999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80307,null,"See CPT",null,88.238799999999998,null,88.238799999999998,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"]
[80338,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"]
[80364,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80376,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80418,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80422,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81001,null,"See CPT",null,4.5013999999999994,null,4.5013999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81025,null,"See CPT",null,12.226199999999999,null,12.226199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81105,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81163,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81171,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81183,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81200,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81207,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81215,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81228,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81231,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81243,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81250,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81262,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81274,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81284,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81289,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"]
[81305,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81317,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81324,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81336,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81343,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81357,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81376,null,"See CPT",null,173.55239999999998,null,173.55239999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81379,null,"See CPT",null,476.2396,null,476.2396,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81401,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81414,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81422,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81438,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81448,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"]
[81514,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81520,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,10214.06,null,10214.06,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC"]
[81560,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82016,null,"See CPT",null,23.415799999999997,null,23.415799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82088,null,"See CPT",null,57.864999999999995,null,57.864999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82120,null,"See CPT",null,8.5058000000000007,null,8.5058000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82160,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82252,null,"See CPT",null,6.4751999999999992,null,6.4751999999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82300,null,"See CPT",null,33.568799999999996,null,33.568799999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82340,null,"See CPT",null,8.5625999999999998,null,8.5625999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82382,null,"See CPT",null,38.765999999999998,null,38.765999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82387,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82495,null,"See CPT",null,28.797599999999999,null,28.797599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82540,null,"See CPT",null,6.5887999999999991,null,6.5887999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82607,null,"See CPT",null,21.413599999999999,null,21.413599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82656,null,"See CPT",null,16.372599999999998,null,16.372599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82672,null,"See CPT",null,30.813999999999997,null,30.813999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[82705,null,"See CPT",null,7.2419999999999991,null,7.2419999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82760,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82777,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82943,null,"See CPT",null,20.291799999999999,null,20.291799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82952,null,"See CPT",null,5.5663999999999998,null,5.5663999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83003,null,"See CPT",null,23.671400000000002,null,23.671400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83015,null,"See CPT",null,29.7348,null,29.7348,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83051,null,"See CPT",null,10.380199999999999,null,10.380199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83068,null,"See CPT",null,13.4474,null,13.4474,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83518,null,"See CPT",null,13.688800000000001,null,13.688800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83527,null,"See CPT",null,28.144399999999997,null,28.144399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83630,null,"See CPT",null,27.973999999999997,null,27.973999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83663,null,"See CPT",null,26.8522,null,26.8522,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[83722,null,"See CPT",null,48.549799999999998,null,48.549799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[83835,null,"See CPT",null,24.0548,null,24.0548,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83916,null,"See CPT",null,38.893799999999999,null,38.893799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83921,null,"See CPT",null,30.118199999999998,null,30.118199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84060,null,"See CPT",null,10.848799999999999,null,10.848799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84081,null,"See CPT",null,23.458399999999997,null,23.458399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84133,null,"See CPT",null,6.7166000000000006,null,6.7166000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84145,null,"See CPT",null,38.652399999999993,null,38.652399999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84165,null,"See CPT",null,15.2508,null,15.2508,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84202,null,"See CPT",null,20.376999999999999,null,20.376999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84252,null,"See CPT",null,28.740799999999997,null,28.740799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84270,null,"See CPT",null,30.8566,null,30.8566,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[84402,null,"See CPT",null,36.167399999999994,null,36.167399999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[84433,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84466,null,"See CPT",null,18.119199999999999,null,18.119199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84480,null,"See CPT",null,20.1356,null,20.1356,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84545,null,"See CPT",null,10.224,null,10.224,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84585,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84704,null,"See CPT",null,21.711799999999997,null,21.711799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85002,null,"See CPT",null,6.8444000000000003,null,6.8444000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85049,null,"See CPT",null,6.3616000000000001,null,6.3616000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85210,null,"See CPT",null,18.4316,null,18.4316,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85280,null,"See CPT",null,27.477,null,27.477,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85292,null,"See CPT",null,26.880599999999998,null,26.880599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85347,null,"See CPT",null,6.0776000000000003,null,6.0776000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85379,null,"See CPT",null,14.455599999999999,null,14.455599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85421,null,"See CPT",null,14.455599999999999,null,14.455599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85525,null,"See CPT",null,16.812799999999999,null,16.812799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85610,null,"See CPT",null,6.0918000000000001,null,6.0918000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85613,null,"See CPT",null,13.6036,null,13.6036,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86003,null,"See CPT",null,7.412399999999999,null,7.412399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86021,null,"See CPT",null,21.370999999999999,null,21.370999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86077,null,"See CPT",null,96.454800000000006,null,88.119199999999992,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[86148,null,"See CPT",null,22.819399999999998,null,22.819399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86225,null,"See CPT",null,19.5108,null,19.5108,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86256,null,"See CPT",null,17.111000000000001,null,17.111000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86316,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[86320,null,"See CPT",null,42.486400000000003,null,42.486400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86336,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[86343,null,"See CPT",null,17.693200000000001,null,17.693200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86364,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[86403,null,"See CPT",null,16.386799999999997,null,16.386799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86510,null,"See CPT",null,13.6942,null,13.6942,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[86603,null,"See CPT",null,18.275399999999998,null,18.275399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86631,null,"See CPT",null,16.784399999999998,null,16.784399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86638,null,"See CPT",null,17.210399999999996,null,17.210399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86674,null,"See CPT",null,20.9024,null,20.9024,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86694,null,"See CPT",null,20.433800000000002,null,20.433800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86695,null,"See CPT",null,18.729799999999997,null,18.729799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86710,null,"See CPT",null,19.241,null,19.241,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86747,null,"See CPT",null,21.342599999999997,null,21.342599999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86765,null,"See CPT",null,18.2896,null,18.2896,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86790,null,"See CPT",null,18.2896,null,18.2896,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86800,null,"See CPT",null,22.592199999999998,null,22.592199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86830,null,"See CPT",null,135.63839999999999,null,135.63839999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86860,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86870,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86910,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[86945,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86975,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[87071,null,"See CPT",null,14.043800000000001,null,14.043800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87076,null,"See CPT",null,11.473599999999999,null,11.473599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87143,null,"See CPT",null,17.778399999999998,null,17.778399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87150,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[87166,null,"See CPT",null,16.045999999999999,null,16.045999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87188,null,"See CPT",null,9.428799999999999,null,9.428799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87252,null,"See CPT",null,37.019399999999997,null,37.019399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87269,null,"See CPT",null,19.326199999999996,null,19.326199999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87283,null,"See CPT",null,86.335999999999999,null,86.335999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87320,null,"See CPT",null,21.299999999999997,null,21.299999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87341,null,"See CPT",null,14.6686,null,14.6686,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87385,null,"See CPT",null,18.814999999999998,null,18.814999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87426,null,"See CPT",null,50.168599999999998,null,50.168599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[87472,null,"See CPT",null,60.832799999999999,null,60.832799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87491,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[87500,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87520,null,"See CPT",null,44.332399999999993,null,44.332399999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87529,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87541,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87551,null,"See CPT",null,68.500799999999998,null,68.500799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87562,null,"See CPT",null,60.832799999999999,null,60.832799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87625,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[87640,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87800,null,"See CPT",null,62.011400000000002,null,62.011400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87880,null,"See CPT",null,23.4726,null,23.4726,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87905,null,"See CPT",null,17.352399999999999,null,17.352399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[88025,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[88029,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[88104,"TC","See CPT",null,80.974400000000003,null,80.974400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88120,"TC","See CPT",null,1034.8052,null,1034.8052,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"]
[88155,null,"See CPT",null,20.803000000000001,null,20.803000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88166,null,"See CPT",null,24.580199999999998,null,24.580199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88173,26,"See CPT",null,124.43859999999999,null,124.43859999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88188,null,"See CPT",null,111.33980000000001,null,111.33980000000001,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[88199,26,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[88240,null,"See CPT",null,18.5594,null,18.5594,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88272,null,"See CPT",null,57.794000000000004,null,57.794000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88291,null,"See CPT",null,59.54,null,59.54,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[88304,26,"See CPT",null,20.243600000000001,null,20.243600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88311,"TC","See CPT",null,16.075800000000001,null,16.075800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88314,null,"See CPT",null,171.4752,null,171.4752,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88331,null,"See CPT",null,189.3372,null,189.3372,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88333,26,"See CPT",null,110.7444,null,110.7444,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88334,26,"See CPT",null,66.68480000000001,null,66.68480000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88346,"TC","See CPT",null,223.87039999999999,null,223.87039999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88350,26,"See CPT",null,51.2044,null,51.2044,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"]
[88365,null,"See CPT",null,341.16419999999999,null,341.16419999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88367,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88373,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88377,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88380,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88399,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[88749,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"]
[89230,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
[89264,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[89300,null,"See CPT",null,13.972799999999999,null,13.972799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[89343,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89398,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90284,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"]
[90386,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[90471,null,"See CPT",null,37.510199999999998,null,37.510199999999998,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[90625,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"]
[90649,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90660,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"]
[90675,null,"See CPT",null,342.22,null,342.22,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[90687,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90690,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90716,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"]
[90738,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90791,null,"See CPT",null,314.37119999999999,null,269.12079999999997,null,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM"]
[90840,null,"See CPT",null,125.62939999999999,null,111.33980000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[90868,null,"See CPT",null,453.50243489865602,null,453.50243489865602,null,"000",0,0,0,0,0,0,1,0,0,null,"F",null,"Y-CM"]
[90912,null,"See CPT",null,150.04079999999999,null,76.806600000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[90951,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[90954,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[90970,null,"See CPT",null,17.266599999999997,null,17.266599999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[90997,null,"See CPT",null,157.18559999999999,null,157.18559999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[91022,"TC","See CPT",null,192.90960000000001,null,192.90960000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91034,26,"See CPT",null,88.714600000000004,null,88.714600000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91040,26,"See CPT",null,88.119199999999992,null,88.119199999999992,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91113,null,"See CPT",null,1745.1173999999999,null,1745.1173999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91122,null,"See CPT",null,518.59340000000009,null,518.59340000000009,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91132,null,"See CPT",null,854.99439999999993,null,854.99439999999993,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91304,null,"See CPT",null,1.0506E-2,null,1.0506E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[91312,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"]
[92025,null,"See CPT",null,67.875599999999991,null,67.875599999999991,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92065,"TC","See CPT",null,16.075800000000001,null,16.075800000000001,null,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM"]
[92083,"TC","See CPT",null,68.470999999999989,null,68.470999999999989,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92134,"TC","See CPT",null,29.77,null,29.77,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92201,null,"See CPT",null,45.250399999999999,null,40.487200000000001,null,"000",0,0,0,0,0,2,0,0,0,null,"R"]
[92228,null,"See CPT",null,54.181400000000004,null,54.181400000000004,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92250,26,"See CPT",null,38.105600000000003,null,38.105600000000003,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92265,26,"See CPT",null,82.760599999999997,null,82.760599999999997,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92285,"TC","See CPT",null,38.105600000000003,null,38.105600000000003,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92311,null,"See CPT",null,196.482,null,94.0732,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[92352,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[92502,null,"See CPT",null,172.666,null,172.666,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[92518,null,"See CPT",null,149.44539999999998,null,76.806600000000003,null,"000",0,0,0,0,0,2,0,0,0,null,"R",null,"Y-CM"]
[92521,null,"See CPT",null,244.70940000000002,null,244.70940000000002,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[92540,26,"See CPT",null,140.51439999999999,null,140.51439999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92541,26,"See CPT",null,38.105600000000003,null,38.105600000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92546,26,"See CPT",null,26.792999999999999,null,26.792999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92549,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[92565,null,"See CPT",null,38.105600000000003,null,38.105600000000003,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[92582,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,2,0,0,0,null,"X"]
[92588,"TC","See CPT",null,10.1218,null,10.1218,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[92592,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[92611,null,"See CPT",null,168.4982,null,168.4982,null,"000",0,0,0,7,0,0,0,0,0,null,"R",null,"Y-CM"]
[92614,null,"See CPT",null,275.67019999999997,null,119.08,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[92653,null,"See CPT",null,156.59019999999998,null,156.59019999999998,null,"000",0,0,0,0,0,2,0,0,0,null,"R",null,"Y-CM"]
[92921,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[92950,null,"See CPT",null,603.14020000000005,null,323.30219999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[92974,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[92998,null,"See CPT",null,549.55420000000004,null,549.55420000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[93000,null,"See CPT",null,26.792999999999999,null,26.792999999999999,null,"000",0,0,0,4,6,0,0,0,0,null,"R"]
[93050,null,"See CPT",null,29.174599999999998,null,29.174599999999998,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93226,null,"See CPT",null,69.066399999999987,null,69.066399999999987,null,"000",0,0,0,3,6,0,0,0,0,null,"R"]
[93261,26,"See CPT",null,64.898600000000002,null,64.898600000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93268,null,"See CPT",null,339.37799999999999,null,339.37799999999999,null,"000",0,0,0,4,6,0,0,0,0,null,"R"]
[93280,"TC","See CPT",null,82.760599999999997,null,82.760599999999997,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93283,null,"See CPT",null,183.9786,null,183.9786,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93287,"TC","See CPT",null,60.730800000000002,null,60.730800000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93287,26,"See CPT",null,39.891800000000003,null,39.891800000000003,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93293,null,"See CPT",null,85.7376,null,85.7376,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93294,null,"See CPT",null,53.585999999999999,null,53.585999999999999,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[93307,26,"See CPT",null,77.997399999999999,null,77.997399999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93308,26,"See CPT",null,44.655000000000001,null,44.655000000000001,null,"000",0,0,0,1,6,0,0,0,0,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,95.26400000000001,null,95.26400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[93351,null,"See CPT",null,436.4282,null,436.4282,null,"000",0,0,0,1,6,0,9,9,9,null,"R"]
[93352,null,"See CPT",null,63.707800000000006,null,63.707800000000006,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93455,null,"See CPT",null,1900.5168000000001,null,1900.5168000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93456,null,"See CPT",null,2122.6009999999997,null,2122.6009999999997,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93461,"TC","See CPT",null,1863.6020000000001,null,1863.6020000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93463,null,"See CPT",null,173.26140000000001,null,173.26140000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[93567,null,"See CPT",null,65.494,null,65.494,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93572,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[93593,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,2,0,0,0,0,null,"X"]
[93594,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,2,0,0,0,0,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"]
[93602,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"]
[93615,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"]
[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"]
[93621,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"]
[93623,"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"]
[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"]
[93644,"TC","See CPT",null,96.454800000000006,null,96.454800000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93657,null,"See CPT",null,538.83699999999999,null,538.83699999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-UR"]
[93701,null,"See CPT",null,50.608999999999995,null,50.608999999999995,null,"000",0,0,0,3,6,0,0,0,0,null,"R",null,"Y-CM"]
[93793,null,"See CPT",null,20.838999999999999,null,20.838999999999999,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[93799,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[93882,"TC","See CPT",null,192.90960000000001,null,192.90960000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93892,"TC","See CPT",null,500.73140000000001,null,500.73140000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93923,"TC","See CPT",null,204.8176,null,204.8176,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93925,26,"See CPT",null,66.68480000000001,null,66.68480000000001,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93930,26,"See CPT",null,67.280199999999994,null,67.280199999999994,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93971,"TC","See CPT",null,188.74179999999998,null,188.74179999999998,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93980,26,"See CPT",null,105.9812,null,105.9812,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93981,26,"See CPT",null,38.105600000000003,null,38.105600000000003,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93990,null,"See CPT",null,278.05180000000001,null,278.05180000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[94012,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[94150,"TC","See CPT",null,0,null,0,null,"000",0,0,0,1,9,9,9,9,9,null,"B"]
[94375,26,"See CPT",null,25.6022,null,25.6022,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94618,null,"See CPT",null,61.921599999999998,null,61.921599999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94621,26,"See CPT",null,120.86619999999999,null,120.86619999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94680,"TC","See CPT",null,76.806600000000003,null,76.806600000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94681,"TC","See CPT",null,71.447999999999993,null,71.447999999999993,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94726,26,"See CPT",null,21.4344,null,21.4344,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94762,null,"See CPT",null,48.822799999999994,null,48.822799999999994,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[94799,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[95028,null,"See CPT",null,24.411399999999997,null,24.411399999999997,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[95125,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"]
[95133,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"]
[95251,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,2,0,0,0,0,0,null,"X"]
[95706,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"]
[95713,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"]
[95725,null,"See CPT",null,521.57039999999995,null,509.66240000000005,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[95801,"TC","See CPT",null,101.21799999999999,null,101.21799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95805,26,"See CPT",null,101.8134,null,101.8134,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95810,26,"See CPT",null,211.36699999999999,null,211.36699999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95813,null,"See CPT",null,814.50720000000001,null,814.50720000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95819,"TC","See CPT",null,744.84539999999993,null,744.84539999999993,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95824,26,"See CPT",null,69.661799999999999,null,69.661799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95852,null,"See CPT",null,32.747,null,9.5264000000000006,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[95864,"TC","See CPT",null,249.47260000000003,null,249.47260000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95866,26,"See CPT",null,114.3168,null,114.3168,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[95870,26,"See CPT",null,34.533199999999994,null,34.533199999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95875,26,"See CPT",null,103.5996,null,103.5996,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95887,null,"See CPT",null,157.18559999999999,null,157.18559999999999,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[95907,26,"See CPT",null,94.0732,null,94.0732,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95909,"TC","See CPT",null,107.76739999999999,null,107.76739999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95912,null,"See CPT",null,459.05340000000001,null,459.05340000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95922,"TC","See CPT",null,98.241,null,98.241,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95925,null,"See CPT",null,338.18719999999996,null,338.18719999999996,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95929,null,"See CPT",null,451.90859999999998,null,451.90859999999998,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95938,null,"See CPT",null,693.64099999999996,null,693.64099999999996,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95941,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[95958,26,"See CPT",null,400.70420000000001,null,400.70420000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95962,26,"See CPT",null,306.63100000000003,null,306.63100000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95965,26,"See CPT",null,737.70060000000001,null,737.70060000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95977,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[95991,null,"See CPT",null,207.19919999999999,null,71.447999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-UR"]
[96105,null,"See CPT",null,177.42920000000001,null,177.42920000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[96136,null,"See CPT",null,78.592799999999997,null,41.677999999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96159,null,"See CPT",null,40.487200000000001,null,35.128599999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[96361,null,"See CPT",null,23.816000000000003,null,23.816000000000003,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96369,null,"See CPT",null,266.73920000000004,null,266.73920000000004,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96373,null,"See CPT",null,33.937799999999996,null,33.937799999999996,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96413,null,"See CPT",null,248.2818,null,248.2818,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96425,null,"See CPT",null,322.1114,null,322.1114,null,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM"]
[96573,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[96932,null,"See CPT",null,245.90019999999998,null,245.90019999999998,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[97012,null,"See CPT",null,26.197600000000001,null,26.197600000000001,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97036,null,"See CPT",null,65.494,null,65.494,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97129,null,"See CPT",null,41.082599999999999,null,40.487200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[97154,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[97162,null,"See CPT",null,143.66,null,143.66,null,"000",0,0,0,7,5,0,0,0,0,null,"F"]
[97169,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[97598,null,"See CPT",null,82.760599999999997,null,44.059599999999996,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[97750,null,"See CPT",null,63.112400000000001,null,63.112400000000001,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97814,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[98962,null,"See CPT",null,19.648199999999999,null,19.648199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[98975,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99002,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[99053,null,"See CPT",null,23.854031682624004,null,23.854031682624004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[99075,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99155,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99175,null,"See CPT",null,57.753799999999998,null,57.753799999999998,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[99204,null,"See CPT",null,303.05860000000001,null,238.75539999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99233,null,"See CPT",null,213.74859999999998,null,213.74859999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99243,null,"See CPT",null,207.19919999999999,null,159.56720000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99252,null,"See CPT",null,128.60640000000001,null,128.60640000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99307,null,"See CPT",null,71.447999999999993,null,71.447999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99310,null,"See CPT",null,276.86099999999999,null,276.86099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99359,null,"See CPT",null,0,null,0,null,"000",0,0,0,0,0,0,0,0,0,null,"B"]
[99377,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[99392,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99408,null,"See CPT",null,63.112400000000001,null,57.1584,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99418,null,"See CPT",null,70.852599999999995,null,70.852599999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99423,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99450,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99453,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"]
[99474,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99489,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99501,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99509,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99512,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0009U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0013A",null,"See CPT",null,40,null,40,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["0015M",null,"See CPT",null,1853.6253999999997,null,1853.6253999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC"]
["0020U",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0055T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
["0076T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
["0091U",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0094A",null,"See CPT",null,40,null,40,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["0105U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0110T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0114U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0121U",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"]
["0138U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0149U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0152U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0165T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0184T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0205U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0211U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0217U",null,"See CPT",null,3121.6569999999997,null,3121.6569999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["0221T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-UR"]
["0231U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0233U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0264T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0267T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0275T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0293U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0303R",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0330T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0350T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0353T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0378T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0385R",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0403T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0405A",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0413A",null,"See CPT",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0417T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0428T",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"]
["0446T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["0449T",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"]
["0494T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,2,2,1,0,null,"X"]
["0496T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,0,9,9,9,9,null,"X"]
["0509F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0514F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0521F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0526F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0535F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0537T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0553T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0555T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0562T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0569T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0580F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0583T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0620T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
["0623T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,4,0,0,0,0,0,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"]
["0673T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["0682T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-UR"]
["0691T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["0705T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,9,2,9,9,9,null,"X"]
["0712T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,9,9,9,9,9,null,"X"]
["0748T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
["0751T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
["0767T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0770T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
["0777T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["0809V",null,"See CPT",null,8.8597536730559998,null,8.8597536730559998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["0841V",null,"See CPT",null,8.8597536730559998,null,8.8597536730559998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["0892V",null,"See CPT",null,5.207725695744001,null,5.207725695744001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["1005F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1008F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1034F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1038F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1045M",null,"Physical capacities exam (pce)",null,281.87918659929608,null,281.87918659929608,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["1066F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1074M",null,"AP response to vrc/employer request re: RTW",null,36.266513478624006,null,36.266513478624006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1088M",null,"HEALTH SERVICES COORDINATOR-SURGICAL",null,9.8735999999999997,null,9.8735999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1111F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1122M",null,"Ime pain management impairment rating",null,591.36373271289597,null,591.36373271289597,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1129M",null,"Ime - extensive file review by examiner",null,1.197684,null,1.197684,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1134F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1142M",null,"IME Rare add'l provider",null,1290.69,null,1290.69,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["1153M",null,"Coord of hlth svcs, pt present, maint",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1160F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1190M",null,"Comprehensive hearing loss exam",null,712.11,null,712.11,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1221M",null,"Nurse case mgmt visits per unit",null,12.83,null,12.83,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["1230M",null,"Ur contract:  retrospective outpatient review",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1280M",null,"CCM, POST-RECOVERY PHASE, 15 MIN",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1301W",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"]
["1401W",null,"See CPT",null,44.287735048127999,null,44.287735048127999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1502F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2000F",null,"See CPT",null,0,null,0,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,1.7653307443200001,null,1.7653307443200001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["2026F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2035F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2134A",null,"See CPT",null,167.76158729616006,null,167.76158729616006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["3011F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3020F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3044F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3055F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3080F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3093F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3115F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3155F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3200F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3250F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3278F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3290F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3321F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3342F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3353F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3390F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3470F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3475F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3502F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3515F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3750F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3761F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4003F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4018F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4040F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4043F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4055F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4065F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4095F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4135F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4149F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4168F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4177F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4180F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4194F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4221F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4266F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4276F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4450F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4541F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4556F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4559F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["5062F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["5200F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["6102F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["8881H",null,"See CPT",null,738.53219999999999,null,738.53219999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["8902H",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["8970H",null,"See CPT",null,66.641235598080016,null,66.641235598080016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["9006F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["9916M",null,"IND HYGIENIST DAILY PHONE CALLS",null,78.570591840000006,null,78.570591840000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A0080",null,"Noninterest escort in non er",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A0110",null,"Nonemergency transport bus",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A0382",null,"Basic support routine suppls",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A0420",null,"Ambulance waiting 1/2 hr",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A0434",null,"Specialty care transport",null,1348.2918713243123,null,1348.2918713243123,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A0998",null,"Ambulance response/treatment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A2013",null,"Innovamatrix fs, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A2016",null,"Permeaderm b, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4216",null,"Sterile water/saline, 10 ml",null,0.51,null,0.51,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4220",null,"Infusion pump refill kit",null,69.380200000000002,null,69.380200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A4235",null,"Lithium batt for glucose mon",null,7.7243999999999993,null,7.7243999999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4247",null,"Betadine/iodine swabs/wipes",null,18.925599999999996,null,18.925599999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4263",null,"Permanent tear duct plug",null,50.864599999999996,null,50.864599999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4284",null,"Replcmnt breast pump shield",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4286",null,"Replcmnt breastpump lok ring",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4311",null,"Catheter w/o bag 2-way latex",null,20.094000000000001,null,20.094000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4334",null,"Urinary cath leg strap",null,6.6707999999999998,null,6.6707999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4337",null,"Incontinent rectal insert",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4355",null,"Bladder irrigation tubing",null,12.097199999999999,null,12.097199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4363",null,"Ostomy clamp, replacement",null,3.2130000000000001,null,3.2130000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4378",null,"Drainable rubber pch w/o fp",null,41.707799999999999,null,41.707799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4385",null,"Ost skn barrier sld ext wear",null,6.9053999999999993,null,6.9053999999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4393",null,"Urine pch w ex wear bar conv",null,12.260400000000001,null,12.260400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4402",null,"Lubricant per ounce",null,2.1624000000000003,null,2.1624000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4419",null,"Ost pch for bar w flange/flt",null,2.3357999999999999,null,2.3357999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4422",null,"Ost pouch absorbent material",null,0.153,null,0.153,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4434",null,"Ost pch urine w lock flng/ft",null,5.0999999999999996,null,5.0999999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4455",null,"Adhesive remover per ounce",null,1.9278,null,1.9278,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4490",null,"Above knee surgical stocking",null,36.793399999999998,null,36.793399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4554",null,"Disposable underpads",null,0.4592,null,0.4592,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A4570",null,"Splint",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4596",null,"Ces system monthly supp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4616",null,"Tubing (oxygen) per foot",null,8.1600000000000006E-2,null,8.1600000000000006E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4619",null,"Face tent",null,4.5919999999999996,null,4.5919999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4635",null,"Underarm crutch pad",null,11.752703146944,null,11.752703146944,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4642",null,"In111 satumomab",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
["A4672",null,"Drainage ext line, dialysis",null,8.872399999999999,null,8.872399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4708",null,"Acetate conc sol per gallon",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A4730",null,"Fistula cannulation set, ea",null,21.024799999999999,null,21.024799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4755",null,"Comb art/venous blood tubing",null,131.405,null,131.405,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4911",null,"Drain bag/bottle",null,15.768599999999999,null,15.768599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4927",null,"Non-sterile gloves",null,18.515599999999999,null,18.515599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A5071",null,"Urinary pouch w/barrier",null,8.1498000000000008,null,8.1498000000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A5081",null,"Stoma plug or seal, any type",null,3.8250000000000002,null,3.8250000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A5126",null,"Disk/foam pad +or- adhesive",null,1.5504,null,1.5504,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A5505",null,"Diab shoe w/metatarsal bar",null,43.921200000000006,null,43.921200000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["A6022",null,"Collagen drsg>16<=48 sq in",null,28.519200000000001,null,28.519200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6025",null,"Silicone gel sheet, each",null,49.659199999999998,null,49.659199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6209",null,"Foam drsg <=16 sq in w/o bdr",null,10.1388,null,10.1388,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6215",null,"Foam dressing wound filler",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6234",null,"Hydrocolld drg <=16 w/o bdr",null,8.8842000000000017,null,8.8842000000000017,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6237",null,"Hydrocolld drg <=16 in w/bdr",null,10.730399999999999,null,10.730399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6250",null,"Skin seal protect moisturizr",null,37.227999999999994,null,37.227999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6257",null,"Transparent film <= 16 sq in",null,2.0808,null,2.0808,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6411",null,"Non-sterile eye pad",null,10.5124,null,10.5124,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6445",null,"Conform band s w <3\"/yd",null,0.4284,null,0.4284,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6453",null,"Self-adher band w <3\"/yd",null,0.85680000000000001,null,0.85680000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["A6461",null,"Synthetic drsg >16<=48 sq in",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A6532",null,"Compression stocking bk40-50",null,82.691400000000002,null,82.691400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A6535",null,"Gc stocking thighlngth 40-50",null,115.63639999999999,null,115.63639999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A6591",null,"Urinary cath suc pump",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A7006",null,"Filtered nebulizer admin set",null,19.450399999999998,null,19.450399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7020",null,"Interface, cough stim device",null,37.178800000000003,null,37.178800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7031",null,"Replacement facemask interfa",null,79.523600000000002,null,79.523600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7045",null,"Repl exhalation port for pap",null,54.185117761440004,null,54.185117761440004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7502",null,"Replacement diaphragm/fplate",null,67.717799999999997,null,67.717799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7524",null,"Tracheostoma stent/stud/bttn",null,105.009,null,105.009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7527",null,"Trach/laryn tube plug/stop",null,4.8552,null,4.8552,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A9272",null,"Disp wound suct, drsg/access",null,18.4664,null,18.4664,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A9279",null,"Monitoring feature/devicenoc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-CM"]
["A9502",null,"Tc99m tetrofosmin",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
["A9510",null,"Tc99m disofenin",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-PHL"]
["A9529",null,"I131 iodide sol, dx",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
["A9538",null,"Tc99m pyrophosphate",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
["A9553",null,"Cr51 chromate",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
["A9556",null,"Ga67 gallium",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
["A9563",null,"P32 na phosphate",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
["A9577",null,"Inj multihance",null,1.83,null,1.83,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["A9589",null,"Insti hexaminolevulinate hcl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9596",null,"Gallium illuccix 1 millicure",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["A9700",null,"Echocardiography contrast",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["A9901",null,"Delivery/set up/dispensing",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["B4104",null,"Additive for enteral formula",null,1.7957999999999998,null,1.7957999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B4153",null,"Ef hydrolyzed/amino acids",null,1.9787999999999999,null,1.9787999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B4161",null,"Ef ped hydrolyzed/amino acid",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["B4197",null,"Parenteral sol 74-100 gm pro",null,393.89340000000004,null,393.89340000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B9004","RR","Parenteral infus pump portab",null,562.62180000000001,null,562.62180000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["C1713",null,"Anchor/screw bn/bn,tis/bn",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1728",null,"Cath, brachytx seed adm",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1747",null,"Endo, single, urinary tract",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C1756",null,"Cath, pacing, transesoph",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1761",null,"Cath, trans intra litho/coro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C1768",null,"Graft, vascular",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1782",null,"Morcellator",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1817",null,"Septal defect imp sys",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1824",null,"Generator, ccm, implant",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR"]
["C1876",null,"Stent, non-coa/non-cov w/del",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1884",null,"Embolization protect syst",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1897",null,"Lead, neurostim test kit",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2614",null,"Probe, perc lumb disc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C2616",null,"Brachytx, non-str,yttrium-90",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2628",null,"Catheter, occlusion",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["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"]
["C7505",null,"Perq ls&cvt inj vert bodies",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["C7512",null,"Bronch/bpsy(s) w/ ebus",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
["C7524",null,"L hrt angio w/flow resrv",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
["C7531",null,"Angio fem/pop w/ us",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
["C7533",null,"Ptca w/ plcmt brachytx dev",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
["C7546",null,"Rep nph/urt cath w/dil stric",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
["C7553",null,"R&i hrt art/vent ang drg ad",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
["C8908",null,"Mri w/o fol w/cont, breast,",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C8923",null,"2d tte w or w/o fol w/con,co",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C8930",null,"Tte w or w/o contr, cont ecg",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9047",null,"Injection, caplacizumab-yhdp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9055",null,"Inj, brexanolone",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9144",null,"Inj, bupivacaine (posimir)",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["C9148",null,"Inj, teclistamab-cqyv, 0.5mg",null,10.620000000000001,null,10.620000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["C9290",null,"Inj, bupivacaine liposome",null,46.384920000000001,null,46.384920000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["C9363",null,"Integra meshed bil wound mat",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9488",null,"Conivaptan hcl",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9605",null,"Perc d-e cor revasc t cabg b",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9740",null,"Cysto impl 4 or more",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,0,null,10361.459292480002,null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-ONC"]
["C9769",null,"Cysto w/temp pros implant",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["C9773",null,"Revasc lithotr-stent tib/per",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9780",null,"Insert cv cath inf & sup app",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D0170",null,"Re-eval,est pt,problem focus",null,86.4,null,86.4,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D0272",null,"Dental bitewings two images",null,55.2,null,55.2,null,"000",0,0,0,1,0,0,0,0,0,null,"F"]
["D0322",null,"Dental tomographic survey",null,572,null,572,null,"000",0,0,0,1,4,0,0,0,0,null,"F"]
["D0372",null,"Tomo comp series images",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
["D0384",null,"Cone beam ct capture tmj",null,426.4,null,426.4,null,"000",0,0,0,1,4,0,0,0,0,null,"F"]
["D0387",null,"Comp image capture only",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
["D0414",null,"Lab process microbial spec",null,235.2,null,235.2,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D0431",null,"Diag tst detect mucos abnorm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["D0481",null,"Electron microscopy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["D0605",null,"Antibody test pub hlth path",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["D0707",null,"Intraoral periap radio image",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
["D1310",null,"Nutri counsel-control caries",null,0,null,0,null,"000",0,0,0,0,0,0,0,0,0,null,"B"]
["D1354",null,"Int caries med app per tooth",null,102.4,null,102.4,null,"000",0,0,0,5,0,0,0,0,0,null,"F"]
["D1516",null,"Fixed bilat space maint, max",null,495.2,null,495.2,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D1557",null,"Remove fixed bilat maint max",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,5,0,0,0,0,0,null,"X"]
["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"]
["D2335",null,"Resin 4/> surf or w incis an",null,387.2,null,387.2,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D2420",null,"Dental gold foil two surface",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
["D2643",null,"Dental onlay porcelin 3 surf",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
["D2722",null,"Crown resin w/ noble metal",null,1203.2,null,1203.2,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D2781",null,"Crown 3/4 cast base metal",null,1248.8,null,1248.8,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D2790",null,"Crown full cast high noble m",null,1431.2,null,1431.2,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D2931",null,"Prefab stnlss steel crown pe",null,388,null,388,null,"000",0,0,0,5,0,0,0,0,0,null,"F"]
["D2950",null,"Core build-up incl any pins",null,326.39999999999998,null,326.39999999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D2975",null,"Coping",null,709.6,null,709.6,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D3110",null,"Pulp cap direct",null,104.8,null,104.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D3333",null,"Internal root repair",null,415.2,null,415.2,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F"]
["D3425",null,"Root surgery molar",null,1118.4000000000001,null,1118.4000000000001,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F"]
["D3450",null,"Root amputation",null,636.79999999999995,null,636.79999999999995,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D3471",null,"Surg rep root res anterior",null,800.8,null,800.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC"]
["D4210",null,"Gingivectomy/plasty 4 or mor",null,764.8,null,764.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D4245",null,"Apically positioned flap",null,970.4,null,970.4,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D4273",null,"Auto tissue graft 1st tooth",null,1296,null,1296,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D4285",null,"Non-auto graft addl tooth",null,1132.8,null,1132.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D4999",null,"Unspecified periodontal proc",null,240,null,240,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D5224",null,"Immed mand part dent metal",null,2130.4,null,2130.4,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D5284",null,"Rem unilat dent flex base",null,1424.8,null,1424.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC"]
["D5411",null,"Dentures adjust cmplt mand",null,112.8,null,112.8,null,"000",0,0,0,5,0,0,0,0,0,null,"F",null,"Y-CM"]
["D5710",null,"Dentures rebase cmplt maxil",null,728,null,728,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D5721",null,"Dentures rebase part mandbl",null,672.8,null,672.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D5765",null,"Liner compl/partial rem dent",null,724,null,724,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D5863",null,"Overdenture complete max",null,2754.4,null,2754.4,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D5915",null,"Orbital prosthesis",null,7896.8,null,7896.8,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D5932",null,"Postsurgical obturator",null,6333.6,null,6333.6,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D5952",null,"Pediatric speech aid",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["D5955",null,"Palatal lift prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
["D5999",null,"Maxillofacial prosthesis",null,1880,null,1880,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D6012",null,"Endosteal implant",null,2018.4,null,2018.4,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D6060",null,"Abutment supported mtl crown",null,1524,null,1524,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D6068",null,"Abutment supported retainer",null,1615.2,null,1615.2,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D6082",null,"Imp crown porc to base alloy",null,1805.6,null,1805.6,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC"]
["D6091",null,"Repl semi/precision attach",null,649.6,null,649.6,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D6103",null,"Bone graft repair perimplant",null,849.6,null,849.6,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D6106",null,"Tissue regen resorbable",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM"]
["D6190",null,"Radio/surgical implant index",null,569.6,null,569.6,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D6194",null,"Abut support retainer titani",null,1668,null,1668,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D6242",null,"Bridge porcelain nobel metal",null,1284.8,null,1284.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D6548",null,"Porcelain/ceramic retainer",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
["D6608",null,"Onlay porc/crmc 2 surfaces",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
["D6615",null,"Onlay cst nbl mtl >=3 surfac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
["D6780",null,"Crown 3/4 high noble metal",null,1292,null,1292,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D6783",null,"Crown 3/4 porcelain/ceramic",null,1344.8,null,1344.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D7210",null,"Rem imp tooth w mucoper flp",null,348,null,348,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D7240",null,"Impact tooth remov comp bony",null,585.6,null,585.6,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D7286",null,"Biopsy of oral tissue soft",null,423.2,null,423.2,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D7295",null,"Bone harvest,auto graft proc",null,1205.5999999999999,null,1205.5999999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
["D7340",null,"Vestibuloplasty ridge extens",null,1579.2,null,1579.2,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D7415",null,"Excision malig les complicat",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,1,1,0,0,null,"X"]
["D7490",null,"Maxilla or mandible resectio",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"X"]
["D7511",null,"Incision/drain abscess intra",null,444.8,null,444.8,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM"]
["D7710",null,"Maxilla open reduct compound",null,5316.8,null,5316.8,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"F",null,"Y-CM"]
["D7740",null,"Clsd reduct compd mandble fx",null,4032,null,4032,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"F",null,"Y-CM"]
["D7865",null,"Tmj reshaping components",null,8743.2000000000007,null,8743.2000000000007,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM"]
["D7872",null,"Tmj diagnostic arthroscopy",null,3863.2,null,3863.2,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM"]
["D7912",null,"Suture complicate wnd > 5 cm",null,1269.5999999999999,null,1269.5999999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"F"]
["D7944",null,"Bone cutting segmented",null,8096,null,8096,null,"000",0,0,0,0,2,0,0,0,0,null,"F",null,"Y-CM"]
["D7957",null,"Tiss regen edent nonresorb",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D7963",null,"Frenuloplasty",null,608,null,608,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D7998",null,"Intraoral place of fix dev",null,2696,null,2696,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D8020",null,"Limited dental tx transition",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
["D8699",null,"Recement fixed retainer man",null,306.39999999999998,null,306.39999999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC"]
["D8703",null,"Replace broken retainer max",null,348.8,null,348.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC"]
["D9222",null,"Deep anest, 1st 15 min",null,286.39999999999998,null,286.39999999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D9311",null,"Consult w/med hlth care prof",null,215.2,null,215.2,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D9912",null,"Pre-visit patient screening",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["D9932",null,"Clean & inspect rem dent max",null,113.60000000000001,null,113.60000000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D9953",null,"Reline sleep apnea appliance",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
["D9971",null,"Odontoplasty 1-2 teeth",null,196.8,null,196.8,null,"000",0,0,0,0,2,1,0,0,0,null,"F"]
["D9999",null,"Adjunctive procedure",null,265.60000000000002,null,265.60000000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["E0110","NU","Crutch forearm pair",null,105.2538,null,105.2538,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0140","NU","Walker w trunk support",null,390.048,null,390.048,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0147","RR","Walker variable wheel resist",null,59.690400000000004,null,59.690400000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0155","NU","Walker wheel attachment,pair",null,29.018999999999998,null,29.018999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0158","RR","Walker leg extenders set of4",null,3.4578000000000002,null,3.4578000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0172","NU","Seat lift mechanism toilet",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0181","NU","Press pad alternating w/ pum",null,276.11399999999998,null,276.11399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0190",null,"Positioning cushion",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0194","RR","Air fluidized bed",null,3935.2110000000002,null,3935.2110000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0210",null,"Electric heat pad standard",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["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"]
["E0245","NU","Tub stool or bench",null,96.993891083232015,null,96.993891083232015,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0251","NU","Hosp bed fixd ht w/o mattres",null,769.38600000000008,null,769.38600000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0266","NU","Hosp bed total elec w/o matt",null,1787.652,null,1787.652,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0270","RR","Hospital bed institutional t",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E0292","NU","Hosp bed var ht no sr w/matt",null,876.07799999999997,null,876.07799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0293","RR","Hosp bed var ht no sr no mat",null,77.142600000000002,null,77.142600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0297","NU","Hosp bed total elect w/o mat",null,1415.3520000000001,null,1415.3520000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0305","RR","Rails bed side half length",null,17.288999999999998,null,17.288999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0352","NU","Disposable pack w/bowel syst",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0372","RR","Powered air mattress overlay",null,438.39600000000002,null,438.39600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0441","NU","Stationary o2 contents, gas",null,86.302606762944009,null,86.302606762944009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0444","NU","Portable 02 contents, liquid",null,86.302606762944009,null,86.302606762944009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0467",null,"Home vent multi-function",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0471","NU","Rad w/backup non inv intrfc",null,5489.0279999999993,null,5489.0279999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0481","RR","Intrpulmnry percuss vent sys",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0560","NU","Humidifier supplemental w/ i",null,200.51160000000002,null,200.51159999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0575","RR","Nebulizer ultrasonic",null,139.4238,null,139.4238,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0601","NU","Cont airway pressure device",null,919.12199999999996,null,919.12199999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0616","RR","Cardiac event recorder",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0618",null,"Apnea monitor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0636","NU","Pt support & positioning sys",null,13470.221999999998,null,13470.221999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0638","NU","Standing frame sys",null,4952.3899999999994,null,4952.3899999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0641","RR","Multi-position stnd fram sys",null,"By Report ",null,"By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0656","RR","Segmental pneumatic trunk",null,78.387,null,78.387,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0668","RR","Seg pneumatic appl full arm",null,59.149800000000006,null,59.149800000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0673","RR","Pressure pneum appl half leg",null,36.373199999999997,null,36.373199999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0694",null,"Uvl md cabinet sys 6 ft",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0730",null,"Tens four lead",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0755",null,"Electronic salivary reflex s",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0761","NU","Nontherm electromgntc device",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0769",null,"Electric wound treatment dev",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0783","RR","Programmable infusion pump",null,1110.5454,null,1110.5454,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0840","RR","Tract frame attach headboard",null,22.154399999999999,null,22.154399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0870","NU","Tract frame attach footboard",null,157.78380000000001,null,157.78380000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0910","NU","Trapeze bar attached to bed",null,180.13200000000001,null,180.13200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0920","RR","Fracture frame attached to b",null,57.864600000000003,null,57.864599999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0947","RR","Fracture frame attachmnts pe",null,84.802800000000005,null,84.802800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0950","RR","Tray",null,10.8834,null,10.8834,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0955","NU","Cushioned headrest",null,209.61,null,209.61,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0961","NU","Wheelchair brake extension",null,30.039000000000001,null,30.039000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0971","NU","Wheelchair anti-tipping devi",null,48.4602,null,48.4602,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0978","RR","W/c acc,saf belt pelv strap",null,3.6720000000000002,null,3.6720000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0982","NU","Back upholstery, replacement",null,57.058799999999998,null,57.058799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0992","NU","Wheelchair solid seat insert",null,114.9132,null,114.9132,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1005","NU","Pwr seat recline pwr",null,6133.77,null,6133.77,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1006","RR","Pwr seat combo w/o shear",null,753.79020000000003,null,753.79020000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1010","NU","Add pwr leg elevation",null,1319.982,null,1319.982,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1028","RR","W/c manual swingaway",null,20.5428,null,20.5428,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1035","NU","Patient transfer system <300",null,5975.8983358176965,null,5975.8983358176965,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1070","RR","Wheelchair detachable foot r",null,148.58339999999998,null,148.58339999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1085","NU","Hemi-wheelchair fixed arms",null,539.71580000000006,null,539.71580000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1092","RR","Wheelchair wide w/ leg rests",null,174.32820000000001,null,174.32820000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1150","RR","Wheelchair standard w/ leg r",null,110.64960000000001,null,110.64960000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1161","NU","Manual adult wc w tiltinspac",null,3209.43,null,3209.43,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1172","RR","Wheelchair amputee detach ar",null,132.90600000000001,null,132.90600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1222","NU","Wheelchair spec size w/ leg",null,919.32599999999991,null,919.32599999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1225","RR","Manual semi-reclining back",null,54.417000000000002,null,54.417000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1234",null,"Fld ped wc tltnspc w/o seat",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E1270","NU","Wheelchair lightweight leg r",null,1070.796,null,1070.796,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1280","RR","Whchr h-duty det arm leg res",null,176.10300000000001,null,176.10300000000001,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"]
["E1372","NU","Oxy suppl heater for nebuliz",null,189.66899999999998,null,189.66899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1391","RR","Oxygen concentrator, dual",null,167.7696,null,167.7696,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1560","RR","Replace blood leak detector",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1600","NU","Deli/install chrg hemo equip",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1639","RR","Scale, each",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1811","RR","Sps knee device",null,181.917,null,181.917,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1816","RR","Sps ankle device",null,184.81380000000001,null,184.81380000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2103",null,"Adju cgm receiver/monitor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E2203","RR","Frame depth less than 22 in",null,58.772399999999998,null,58.772399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2205","NU","Manual wc accessory, handrim",null,43.900799999999997,null,43.900799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2212","NU","Pneumatic prop tire tube",null,7.8846000000000007,null,7.8846000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2219","NU","Foam caster tire any size ea",null,53.692799999999998,null,53.692799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2230","RR","Manual standing system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E2310","NU","Electro connect btw control",null,1319.1660000000002,null,1319.1660000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2313","RR","Pwc harness, expand control",null,43.462200000000003,null,43.462200000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2323","RR","Special joystick handle",null,8.0172000000000008,null,8.0172000000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2329","RR","Head control nonproportional",null,206.4888,null,206.4888,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2331","NU","Attendant control",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E2358","NU","Gr 34 nonsealed leadacid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E2362","RR","Gr24 nonsealed leadacid",null,12.576600000000001,null,12.576600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2368","RR","Pwr wc drivewheel motor repl",null,55.814399999999999,null,55.814399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2373","NU","Hand/chin ctrl spec joystick",null,939.42,null,939.42,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2381","RR","Pneum drive wheel tire",null,8.1804000000000006,null,8.1804000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2384","RR","Pneumatic caster tire",null,8.5884,null,8.5884,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2390","RR","Solid drive wheel tire",null,4.9062000000000001,null,4.9062000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2392","NU","Solid caster tire, integrate",null,57.925800000000002,null,57.925800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2402","RR","Neg press wound therapy pump",null,1424.8788000000002,null,1424.8788000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["E2506","NU","Sgd prerec msg > 40 min",null,3137.4485999999997,null,3137.4485999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2601","NU","Gen w/c cushion wdth < 22 in",null,60.1494,null,60.1494,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2608","NU","Skin pro/pos wc cus wd>=22in",null,364.02780000000001,null,364.02780000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2621","NU","Wc planar back cush wd>=22in",null,616.5390000000001,null,616.5390000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2633","NU","Mobile arm support supinator",null,185.50740000000002,null,185.50740000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["G0008",null,"Admin influenza virus vac",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["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"]
["G0046",null,"No mrs 90 days post stk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0049",null,"Main hemo in-cntr",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"]
["G0068",null,"Adm of infusion drug in home",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0084",null,"Care man h v ext pt 60 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0105",53,"Colorectal scrn; hi risk ind",null,316.75280000000004,null,163.73499999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
["G0108",null,"Diab manage trn  per indiv",null,100.02719999999999,null,100.02719999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
["G0120","TC","Colon ca scrn; barium enema",null,317.34820000000002,null,317.34820000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
["G0143",null,"Scr c/v cyto,thinlayer,rescr",null,38.411000000000001,null,38.411000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0147",null,"Scr c/v cyto, automated sys",null,24.580199999999998,null,24.580199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0166",null,"Extrnl counterpulse, per tx",null,199.459,null,199.459,null,"000",0,0,0,5,9,9,9,9,9,null,"R"]
["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"]
["G0219",null,"Pet img wholbod melano nonco",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["G0248",null,"Demonstrate use home inr mon",null,186.36019999999999,null,186.36019999999999,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"]
["G0270",null,"Mnt subs tx for change dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0288",null,"Recon, cta for surg plan",null,75.020399999999995,null,75.020399999999995,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
["G0294",null,"Non-cov proc, clinical trial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0318",null,"Prolong home eval add 15m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0329",null,"Electromagntic tx for ulcers",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,7,5,0,0,0,0,null,"X"]
["G0379",null,"Direct refer hospital observ",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["G0396",null,"Alcohol/subs interv 15-30mn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0409",null,"Corf related serv 15 mins ea",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,0,0,0,0,0,null,"X"]
["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"]
["G0429",null,"Dermal filler injection(s)",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
["G0435",null,"Oral hiv-1/hiv-2 screen",null,17.011600000000001,null,17.011600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0451",null,"Devlopment test interpt&rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,5,0,0,0,0,0,null,"X"]
["G0460",null,"Autologous prp for ulcers",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["G0475",null,"Hiv combination assay",null,34.193599999999996,null,34.193599999999996,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,95.857459416576006,null,64.13667260457602,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["G0511",null,"Ccm/bhi by rhc/fqhc 20min mo",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,9,9,9,9,9,null,"X"]
["G1002",null,"Cdsm medcurrent",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"]
["G1021",null,"Cdsm ehealthline",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G1028",null,"Take home supply 8mg per 0.1",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2012",null,"Brief check in by md/qhp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G2066",null,"Inter devc remote 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
["G2078",null,"Take-home meth",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2081",null,"Pt 66+ snp or ltc pos > 90d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2099",null,"Pt 66+ frailty and adv ill",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2106",null,"Pt 66+ lt ints > 90",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2129",null,"No bp outpt",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"]
["G2150",null,"No mpm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2173",null,"Uri w comorb 12m oth dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2185",null,"Caregiver dem trained",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2188",null,"Pt 50 yrs w/clin ind hd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2207",null,"Rsn no trtmt chem her2",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2215",null,"Home supply nasal naloxone",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4003",null,"Emergency med ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4006",null,"Gastroenterology ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4018",null,"Ob/gyn ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4025",null,"Physical medicine ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4037",null,"Urology ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G6002",26,"Stereoscopic x-ray guidance",null,37.510199999999998,null,37.510199999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
["G6014",null,"Radiation treatment delivery",null,449.52699999999999,null,449.52699999999999,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"]
["G8419",null,"Calc bmi out nrm param nof/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8427",null,"Docrev cur meds by elig clin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8475",null,"Ace/arb thxpy not rx'd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8506",null,"Pt rec ace/arb",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8561",null,"Pt inelig for ref oto eval",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"]
["G8633",null,"Pharm ther osteo rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8648",null,"Rafscrs ki scor < 0",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8667",null,"Rafscrs ewh scor >= 0",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8694",null,"Lvef <40%",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8733",null,"Doc pos elder mal scrn plan",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8755",null,"Dias bp > or = 90",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8818",null,"Pt disch to home by day#7",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8840",null,"Doc reas no sleep apnea",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8855",null,"Pos air press adhere no perf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8858",null,"Not ref for oto eval",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8884",null,"Doc reas biopsy not review",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8908",null,"Pt doc w burn prior to d/c",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8915",null,"Pt not trans to hosp at d/c",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8944",null,"Ajcc mel cnr stg 0 - iic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8966",null,"Csit perf sx or high chd rsk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9003",null,"Mccd, risk adj hi, initial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9016",null,"Demo-smoking cessation coun",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9052",null,"Onc surveillance for disease",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9068",null,"Onc dx sclc/nsclc limited",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9069",null,"Onc dx sclc/nsclc ext at dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9078",null,"Onc dx prostate t2no progres",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9092",null,"Onc dx rectal t1-3,n1-2noprg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9104",null,"Onc dx gastric unknown nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9111",null,"Onc dx head/neck m1 mets rec",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9129",null,"Onc dx mult myeloma stg2 hig",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9132",null,"Onc dx prostate mets no cast",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9190",null,"Medical reason for no beta",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"]
["G9230",null,"Norsn for gc chl syp test",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9275",null,"Doc of non tobacco user",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9287",null,"No antibio w in 10d of sympt",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9294",null,"Pt cat and thck on report",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9311",null,"No surg site infection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9318",null,"Image std nomenclature",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"]
["G9357",null,"Pp eval/edu perf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9383",null,"Recd scrn hcv infec",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9404",null,"No 30 day f/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9416",null,"Pt 1 tdap betw 10-13 yrs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9423",null,"Med reas rpt no histo type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9452",null,"Doc med reas no scrn hcv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9459",null,"Tob non-user",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9480",null,"Admission to mccm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9500",null,"Rad expos ind/exp tm doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9509",null,"Adit mdd dys rem 12 mnths",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"]
["G9537",null,"Doc sysm rsn img hd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9552",null,"Inc thyr node <1.0 in rpt",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9597",null,"No low pecarn ped head traum",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9607",null,"Doc med rsn not perf cystosc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9626",null,"Med rsn no rpt baldder inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9629",null,"Med rsn no rpt bowel inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9645",null,"Had smoke b/4 anes day surg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9661",null,">85y scope othr rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9675",null,"Pt w/fast/dir lab ldl-c >190",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9697",null,"Pt rsn no presc bronchdil",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9710",null,"Pt prov hosp srv msmt per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9717",null,"Doc pt dx dep/bp f/u nt req",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9730",null,"Refused to participate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9733",null,"Pt unbl cmplt lb fs prom",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9744",null,"Pt not eli d/t act dig htn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9761",null,"Pt w/hosp anytime msmt per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9770",null,"Perip nerve block",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9781",null,"Doc rsn no statin",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"]
["G9812",null,"Pt died during inpt/30d aft",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9838",null,"Pt met dis at dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9845",null,"Pt recd anti-egfr ther",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9848",null,"Pt no chemo last 14d life",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9877",null,"2 em core ms mo 10-12 no wl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9891",null,"Em session reporting",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9900",null,"Scrn mam perf rslts not doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9915",null,"No documntd hbv results rcd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9922",null,"Sfty cncrns scrn nd mit recs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9943",null,"Bk pn nt msr vas scl pre/pst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9957",null,"Doc med rsn no combo thrpy",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"]
["G9977",null,"DIL MAC EXAM NO PERF RSN NOS ",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9993",null,"Pall serv during meas",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0006",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"]
["H0024",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"]
["H0036",null,"Comm psy face-face per 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0043",null,"Supported housing, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0046",null,"Mental health service, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H1011",null,"Family assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2014",null,"Skills train and dev, 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2026",null,"Supp maint employ, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2032",null,"Activity therapy, per 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0131",null,"Acetaminophen injection",null,0.1,null,0.1,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0180",null,"Agalsidase beta injection",null,208.17,null,208.17,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0208",null,"Inj sodium thiosulfate 100mg",null,"Not Covered",null,98.64,null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-CM"]
["J0218",null,"Inj olipudase alfa-rpcp 1mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0275",null,"Alprostadil urethral suppos",null,65.12,null,65.12,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0288",null,"Ampho b cholesteryl sulfate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0380",null,"Inj metaraminol bitartrate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0480",null,"Basiliximab",null,4310.97,null,4310.97,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0558",null,"Peng benzathine/procaine inj",null,14.42,null,14.42,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0585",null,"Injection,onabotulinumtoxina",null,6.32,null,6.32,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0594",null,"Busulfan injection",null,1.87,null,1.87,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0597",null,"C-1 esterase, berinert",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0670",null,"Inj mepivacaine hcl/10 ml",null,3.47,null,3.47,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0691",null,"Inj lefamulin 1 mg",null,0.72,null,0.72,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0710",null,"Cephapirin sodium injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0739",null,"Injection, cabotegravir 1 mg",null,4.9400000000000004,null,4.9400000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["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"]
["J0879",null,"Difelikefalin, esrd on dialy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["J0888",null,"Epoetin beta non esrd",null,1.97,null,1.97,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0892",null,"Argatroban dialysis (accord)",null,0.42,null,0.42,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1096",null,"Dexametha opth insert 0.1 mg",null,134.71,null,134.71,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1110",null,"Inj dihydroergotamine mesylt",null,57.8,null,57.8,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1212",null,"Dimethyl sulfoxide 50% 50 ml",null,638.70000000000005,null,638.70000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1267",null,"Doripenem injection",null,0.79,null,0.79,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1327",null,"Eptifibatide injection",null,6.67,null,6.67,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1429",null,"Inj golodirsen 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1442",null,"Inj filgrastim excl biosimil",null,0.98,null,0.98,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1445",null,"Inj triferic avnu 0.1mg iron",null,0.42230000000000001,null,0.42230000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1554",null,"Inj. asceniv",null,482.27,null,482.27,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J1557",null,"Gammaplex injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1573",null,"Hepagam b intravenous, inj",null,84.84,null,84.84,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1602",null,"Golimumab for iv use 1mg",null,13.85,null,13.85,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1644",null,"Inj heparin sodium per 1000u",null,0.26,null,0.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1670",null,"Tetanus immune globulin inj",null,545.62,null,545.62,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1743",null,"Idursulfase injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1746",null,"Inj., ibalizumab-uiyk, 10 mg",null,69.61,null,69.61,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1850",null,"Kanamycin sulfate 75 mg inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1930",null,"Lanreotide injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1956",null,"Levofloxacin injection",null,0.84,null,0.84,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2021",null,"Inj, linezolid (hospira)",null,15.26,null,15.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J2247",null,"Inj, micafungin (par pharm)",null,0.37,null,0.37,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J2281",null,"Inj moxifloxacin (fres kabi)",null,8.77,null,8.77,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J2325",null,"Nesiritide 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"]
["J2425",null,"Palifermin injection",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"]
["J2550",null,"Promethazine hcl injection",null,3.11,null,3.11,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2590",null,"Oxytocin injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2725",null,"Inj protirelin per 250 mcg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2786",null,"Injection, reslizumab, 1mg",null,10.16,null,10.16,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J2795",null,"Ropivacaine hcl injection",null,0.08,null,0.08,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2798",null,"Inj., perseris, 0.5 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2995",null,"Inj streptokinase /250000 iu",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3000",null,"Streptomycin injection",null,42.26,null,42.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3240",null,"Thyrotropin injection",null,1926.74,null,1926.74,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3244",null,"Inj. tigecycline (accord)",null,0.6,null,0.6,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J3302",null,"Triamcinolone diacetate inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3320",null,"Spectinomycn di-hcl inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3364",null,"Urokinase 5000 iu injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3397",null,"Inj., vestronidase alfa-vjbk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3485",null,"Zidovudine",null,1.51,null,1.51,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3490",null,"Drugs unclassified injection",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["J7121",null,"5% dextrose in lac ringers",null,2.86,null,2.86,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7169",null,"Inj andexxa, 10 mg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["J7187",null,"Humate-p, inj",null,1.35,null,1.35,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7194",null,"Factor ix complex",null,1.58,null,1.58,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7200",null,"Factor ix recombinan rixubis",null,1.57,null,1.57,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"]
["J7310",null,"Ganciclovir long act implant",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7313",null,"Inj., iluvien, 0.01 mg",null,490.95,null,490.95,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7331",null,"Synojoynt, inj., 1 mg",null,13.25,null,13.25,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7340",null,"Carbidopa levodopa ent 100ml",null,219.76,null,219.76,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7507",null,"Tacrolimus imme rel oral 1mg",null,0.35,null,0.35,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7515",null,"Cyclosporine oral 25 mg",null,0.75,null,0.75,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7608",null,"Acetylcysteine non-comp unit",null,6.2,null,6.2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7612",null,"Levalbuterol non-comp con",null,0.27,null,0.27,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7634",null,"Budesonide comp con",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7637",null,"Dexamethasone comp con",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7660",null,"Isoproterenol comp unit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7668",null,"Metaproterenol non-comp con",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7681",null,"Terbutaline sulf comp unit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J8510",null,"Oral busulfan",null,23.42,null,23.42,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J8650",null,"Nabilone oral",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["J8705",null,"Topotecan oral",null,104.37,null,104.37,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9033",null,"Inj., treanda 1 mg",null,14.37,null,14.37,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9037",null,"Inj belantamab mafodont blmf",null,43.158000000000001,null,43.158000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J9065",null,"Inj cladribine per 1 mg",null,18.88,null,18.88,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9098",null,"Cytarabine liposome inj",null,628.37,null,628.37,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9145",null,"Injection, daratumumab 10 mg",null,60.77,null,60.77,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9178",null,"Inj, epirubicin hcl, 2 mg",null,1.3,null,1.3,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9204",null,"Inj mogamulizumab-kpkc, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9211",null,"Idarubicin hcl injection",null,44.38,null,44.38,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9218",null,"Leuprolide acetate injeciton",null,8.01,null,8.01,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9229",null,"Inj inotuzumab ozogam 0.1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9271",null,"Inj pembrolizumab",null,55.42,null,55.42,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J9274",null,"Inj, tebentafusp-tebn, 1 mcg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9296",null,"Inj pemetrexed (accord) 10mg",null,9.74,null,9.74,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9309",null,"Inj, polatuzumab vedotin 1mg",null,118.11,null,118.11,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J9330",null,"Temsirolimus injection",null,32.17,null,32.17,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9352",null,"Injection trabectedin 0.1mg",null,331.83,null,331.83,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9359",null,"Inj lon tesirin-lpyl 0.075mg",null,191.42,null,191.42,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["K0001","NU","Standard wheelchair",null,508.06200000000001,null,508.06200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0007","NU","Extra heavy duty wheelchair",null,1775.9220000000003,null,1775.9220000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0008","NU","Cstm manual wheelchair/base",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["K0011","RR","Stnd wt pwr whlchr w control",null,694.88520000000005,null,694.88520000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0018","NU","Detach adjust armrst upper",null,32.303400000000003,null,32.303400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0040","NU","Adjustable angle footplate",null,76.561199999999999,null,76.561199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0043","RR","Ftrst lowr exten tube rep ea",null,2.2644000000000002,null,2.2644000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0051","RR","Cam rel asm ft/legrst rep ea",null,6.0282,null,6.0282,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0056","NU","Seat ht <17 or >=21 ltwt wc",null,122.5428,null,122.5428,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0108","RR","W/c component-accessory nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0455","NU","Pump uninterrupted infusion",null,3592.7460000000001,null,3592.7460000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0604","NU","Repl batt lithium 3.6 v",null,8.1498000000000008,null,8.1498000000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0739",null,"Repair/svc dme non-oxygen eq",null,29.101800000000001,null,29.101800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0812","NU","Power operated vehicle noc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0816","NU","Pwc gp 1 std cap chair",null,4714.848,null,4714.848,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0825","NU","Pwc gp 2 hd cap chair",null,6410.0880000000006,null,6410.0880000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0827","RR","Pwc gp vhd cap chair",null,870.21299999999997,null,870.21299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0837","NU","Pwc gp 2 hd sing pow opt s/b",null,6944.058,null,6944.058,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0838","RR","Pwc gp 2 hd sing pow opt cap",null,618.97680000000003,null,618.97680000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0842","NU","Pwc gp2 std mult pow opt cap",null,6153.7619999999988,null,6153.7619999999988,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0852","NU","Pwc gp 3 vhd seat/back",null,12420.642,null,12420.642,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0855","RR","Pwc gp 3 xhd cap chair",null,1596.7488000000001,null,1596.7488000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0861","RR","Pwc gp3 std mult pow opt s/b",null,996.33600000000001,null,996.33600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0870","RR","Pwc gp 4 hd seat/back",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0879","NU","Pwc gp4 hd 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"]
["K0899","NU","Pow mobil dev no dmepdac",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"]
["K1016",null,"Trans elec nerv for trigemin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K1023",null,"Trans elec nerv periph nerv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["L0112",null,"Cranial cervical orthosis",null,1911.2886000000001,null,1911.2886000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0200",null,"Cerv col supp adj bar & thor",null,865.01659999999993,null,865.01659999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0457",null,"Tlso flex trnk sj-ss pre ots",null,1124.5228,null,1124.5228,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0469",null,"Tlso rig fram pelvic pre ots",null,592.38319999999999,null,592.38319999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0492",null,"Tlso 3 piece rigid shell",null,689.81239999999991,null,689.81239999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0623",null,"Sio rig pnl pelv/sac pre ots",null,199.89699999999999,null,199.89699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0635",null,"Lso sagit rigid panel prefab",null,1442.9915999999998,null,1442.9915999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0642",null,"Lo sag ri an/pos pnl pre ots",null,464.82,null,464.82,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L0861",null,"Halo repl liner/interface",null,294.32499999999999,null,294.32499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1005",null,"Tension based scoliosis orth",null,4370.7110000000002,null,4370.7110000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1060",null,"Thoracic pad",null,147.40039999999999,null,147.40039999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1240",null,"Lumbar derotation pad",null,108.56779999999999,null,108.56779999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1300",null,"Body jacket mold to patient",null,2209.9202,null,2209.9202,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1600",null,"Ho flex frejka w/cov pre cst",null,168.5796,null,168.5796,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1700",null,"Leg perthes orth toronto typ",null,2148.6152000000002,null,2148.6152000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1820",null,"Ko elas w/ condyle pads & jo",null,188.7218,null,188.7218,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1847",null,"Ko dbl upright w/air pre cst",null,785.43599999999992,null,785.43599999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1920",null,"Afo sing upright w/ adjust s",null,586.19780000000003,null,586.19780000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L1960",null,"Afo pos solid ank plastic mo",null,725.13139999999999,null,725.13139999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2035",null,"Kafo plastic pediatric size",null,245.708,null,245.708,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2060",null,"Hkafo torsion ball bearing j",null,894.83339999999998,null,894.83339999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2090",null,"Hkafo unilat torsion ball br",null,764.84239999999988,null,764.84239999999988,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2182",null,"Drop lock knee",null,140.971,null,140.971,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2210",null,"Dorsiflexion assist each joi",null,92.183199999999999,null,92.183199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2310",null,"Abduction bar-straight",null,214.58579999999998,null,214.58579999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2370",null,"Patten bottom",null,358.85079999999999,null,358.85079999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2492",null,"Knee lift loop drop lock rin",null,138.31139999999999,null,138.31139999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2610",null,"Hip clevis/thrust bearing lo",null,375.06459999999998,null,375.06459999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L2640",null,"Pelvic control band & belt b",null,533.31079999999997,null,533.31079999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2780",null,"Non-corrosive finish",null,118.0472,null,118.0472,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2820",null,"Soft interface below knee se",null,113.60640000000001,null,113.60640000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3001",null,"Foot insert remov molded spe",null,180.62100000000001,null,180.62100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3090",null,"Arch supp att to shoe long/m",null,55.595399999999998,null,55.595399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L3202",null,"Oxford w/ supinat/pronator c",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X","Y","Y-CM"]
["L3216",null,"Orthoped ladies shoes dpth i",null,132.56190000000001,null,132.56190000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L3254",null,"Orth foot non-stndard size/w",null,30.710999999999999,null,30.710999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3320",null,"Shoe lift elev heel/sole cor",null,178.12380000000002,null,178.12380000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3390",null,"Shoe outflare wedge",null,67.685599999999994,null,67.685599999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3440",null,"Heel leather reinforced",null,104.22460000000001,null,104.22460000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L3485",null,"Shoe heel pad removable for",null,40.542000000000002,null,40.542000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3600",null,"Trans shoe calip plate exist",null,104.22460000000001,null,104.22460000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3660",null,"So 8 ab rstr can/web pre ots",null,131.577,null,131.577,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3760",null,"Eo adj jt prefab custom fit",null,621.49239999999998,null,621.49239999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3900",null,"Hinge extension/flex wrist/f",null,1864.3186000000001,null,1864.3186000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3913",null,"Hfo w/o joints cf",null,336.59799999999996,null,336.59799999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["L3917",null,"Metacarp fx orthosis pre cst",null,131.34520000000001,null,131.34520000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["L3962",null,"Sewho erbs palsey design abd",null,1143.201,null,1143.201,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L3971",null,"Sewho cap design w/jnt(s) cf",null,2340.1186000000002,null,2340.1186000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L4000",null,"Repl girdle milwaukee orth",null,1894.9772,null,1894.9772,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-UR"]
["L4050",null,"Replace molded calf lacer",null,650.71140000000003,null,650.71140000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L4360",null,"Pneumat walking boot pre cst",null,482.97359999999998,null,482.97359999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5010",null,"Mold socket ank hgt w/ toe f",null,1766.3414,null,1766.3414,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5160",null,"Mold socket bent knee shin s",null,7217.2956999999997,null,7217.2956999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5220",null,"No knee joint with artic ali",null,5335.7779999999993,null,5335.7779999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5500",null,"Init bk ptb plaster direct",null,1863.3694,null,1863.3694,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5510",null,"Prep bk ptb plaster molded",null,2288.8067000000001,null,2288.8067000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5610",null,"Above knee hydracadence",null,3853.7006999999999,null,3853.7006999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5620",null,"Test socket below knee",null,430.36490000000003,null,430.36490000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5638",null,"Below knee leather socket",null,800.39210000000003,null,800.39210000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5646",null,"Below knee cushion socket",null,850.95079999999996,null,850.95079999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5661",null,"Multi-durometer symes",null,882.91670000000011,null,882.91670000000011,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5668",null,"Bk molded distal cushion",null,162.7886,null,162.7886,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5688",null,"Bk waist belt webbing",null,101.2444,null,101.2444,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5692",null,"Ak pelvic control belt light",null,226.26320000000001,null,226.26320000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5705",null,"Custom shape cover ak",null,1452.4863,null,1452.4863,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5716",null,"Knee-shin exo mech stance ph",null,1057.4401,null,1057.4401,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5810",null,"Endoskel knee-shin mnl lock",null,806.62779999999998,null,806.62779999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5824",null,"Endo knee-shin fluid swing p",null,2224.9765000000002,null,2224.9765000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5859",null,"Knee-shin pro flex/ext cont",null,21899.651399999999,null,21899.651399999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L5925",null,"Above knee manual lock",null,632.77750000000003,null,632.77750000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5975",null,"Combo ankle/foot prosthesis",null,660.28570000000002,null,660.28570000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5978",null,"Ft prosth multiaxial ankl/ft",null,513.33399999999995,null,513.33399999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6000",null,"Part hand thumb rem",null,2570.3276000000001,null,2570.3276000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6110",null,"Elbow mold sock suspension t",null,3460.5340999999999,null,3460.5340999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6380",null,"Postop dsg cast chg wrst/elb",null,1983.9940000000001,null,1983.9940000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6500",null,"Above elbow prosth tiss shap",null,5157.2921999999999,null,5157.2921999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6611",null,"Additional switch, ext power",null,586.4479,null,586.4479,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6620",null,"Flexion/extension wrist unit",null,485.66070000000002,null,485.66070000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6646",null,"Multipo locking shoulder jnt",null,4492.2566999999999,null,4492.2566999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6650",null,"Shoulder universal joint",null,496.04929999999996,null,496.04929999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6680",null,"Test sock wrist disart/bel e",null,345.1352,null,345.1352,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6692",null,"Silicone gel insert or equal",null,811.36490000000003,null,811.36490000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6709",null,"Term dev mech hand vol close",null,2041.6646999999998,null,2041.6646999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6722",null,"Hook/hand, hvy dty, vol clos",null,2887.8784000000001,null,2887.8784000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6905",null,"Hand restoration multiple fi",null,2840.2280000000001,null,2840.2280000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L6920",null,"Wrist disarticul switch ctrl",null,11289.6523,null,11289.6523,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L7045",null,"Pediatric electric hook",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["L7181",null,"Electronic elbo simultaneous",null,57069.240700000002,null,57069.240700000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L7366",null,"Battery chrgr 12 volt utah/e",null,977.2269,null,977.2269,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L7499",null,"Upper extremity prosthes nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L8020",null,"Mastectomy form",null,349.5421,null,349.5421,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8040",null,"Nasal prosthesis",null,3561.0038,null,3561.0038,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8320",null,"Truss addition to std pad wa",null,81.089500000000001,null,81.089500000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8430",null,"Prosthetic sock multi ply ak",null,33.235900000000001,null,33.235900000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8507",null,"Trach-esoph voice pros pt in",null,59.651899999999998,null,59.651899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8511",null,"Indwelling trach insert",null,103.59389999999999,null,103.59389999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8614",null,"Cochlear device",null,27255.6224,null,27255.6224,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8617",null,"Coch implant trans coil repl",null,130.68300000000002,null,130.68300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8630",null,"Metacarpophalangeal implant",null,488.79759999999999,null,488.79759999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8678",null,"Ext sply implt neurostim",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["L8690",null,"Aud osseo dev, int/ext comp",null,6775.6912999999995,null,6775.6912999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8698",null,"Misc used with tot art heart",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["M0076",null,"Prolotherapy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M0222",null,"Bebteleovimab injection",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["M1005",null,"Tb scr no perf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["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"]
["M1021",null,"Pt uc in pp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1036",null,"Adt no 180 dys pharmthry oud",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1054",null,"Pt uc in pp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1067",null,"Hspc pt prv time meam per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1114",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"]
["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"]
["M1152",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"]
["M1160",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"]
["M1172",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"]
["M1179",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"]
["M1191",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"]
["M1194",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"]
["M1210",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"]
["P2031",null,"Hair analysis",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"]
["P9031",null,"Platelets leukocytes reduced",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9044",null,"Cryoprecipitatereducedplasma",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9052",null,"Platelets, hla-m, l/r, unit",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9099",null,"Blood component/product noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["P9604",null,"One-way allow prorated trip",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0115",null,"Post-coital mucous exam",null,35.5,null,35.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["Q0144",null,"Azithromycin dihydrate, oral",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0169",null,"Promethazine hcl 12.5mg oral",null,0.02,null,0.02,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q0247",null,"Sotrovimab",null,2465.8200000000002,null,2465.8200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q0485",null,"Monitor cable elec 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"]
["Q0504",null,"Pwr adpt pneum vad, rep veh",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0512",null,"Px sup fee anti-can sub pres",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2036",null,"Flulaval vacc, 3 yrs & >, im",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2039",null,"Influenza virus vaccine, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2054",null,"Lisocabtagene mara car pos t",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q4006",null,"Cast sup long arm adult fbrg",null,35.414400000000001,null,35.414400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["Q4016",null,"Cast sup gauntlet ped fbrgls",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4023",null,"Cast sup sht arm splnt ped p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4035",null,"Cast sup lngleg cylndr ped p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4042",null,"Cast sup lng leg splnt fbrgl",null,41.391599999999997,null,41.391599999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4082",null,"Drug/bio noc part b drug cap",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4102",null,"Oasis wound matrix",null,12.71,null,12.71,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q4110",null,"Primatrix",null,40.700000000000003,null,40.700000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q4124",null,"Oasis tri-layer wound matrix",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4137",null,"Amnioexcel biodexcel 1sq cm",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"]
["Q4157",null,"Revitalon 1 square cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4164",null,"Helicoll, per square cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4177",null,"Floweramnioflo, 0.1 cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4180",null,"Revita, per sq cm",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"]
["Q4219",null,"Surgigraft dual per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4232",null,"Corplex, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4240",null,"Corecyte topical only 0.5 cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4253",null,"Zenith amniotic membrane psc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4260",null,"Signature apatch, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q5001",null,"Hospice or home hlth in home",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q5004",null,"Hospice in snf",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q5101",null,"Injection, zarxio",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q5119",null,"Inj ruxience, 10 mg",null,29.97,null,29.97,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q5126",null,"Inj alymsys 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q9956",null,"Inj octafluoropropane mic,ml",null,32.770000000000003,null,32.770000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q9965",null,"Locm 100-199mg/ml iodine,1ml",null,1.55,null,1.55,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["R0070",null,"Transport portable x-ray",null,197.507410337952,null,197.50741033795202,null,"000",0,0,0,3,0,0,0,0,0,null,"F"]
["R0340",null,"Retraining books",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["R0399",null,"TRAINING, OPTION 2, VOC COUNSELING ",null,10.390434000000001,null,10.390434000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S0014",null,"Tacrine hydrochloride, 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0074",null,"Injection, cefotetan disodiu",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0091",null,"Granisetron 1mg",null,6.25,null,6.25,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["S0137",null,"Didanosine, 25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0157",null,"Becaplermin gel 1%, 0.5 gm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0172",null,"Chlorambucil 2 mg",null,26.52,null,26.52,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["S0191",null,"Misoprostol, oral, 200 mcg",null,0.95,null,0.95,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["S0209",null,"Wc van mileage per mi",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S0221",null,"Medical conference, 60 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S0281",null,"Medical home, maintenance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S0340",null,"Lifestyle mod 1st stage",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S0510",null,"Non-prscrp lens",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S0601",null,"Screening proctoscopy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0621",null,"Routine ophthalmological exa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S1034",null,"Art pancreas system",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S2054",null,"Transplantation of multivisc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S2061",null,"Donor lobectomy (lung)",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S2107",null,"Adoptive immunotherapy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S2142",null,"Cord blood-derived stem-cell",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2260",null,"Induced abortion 17-24 weeks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2400",null,"Fetal surg congen hernia",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2409",null,"Fetal surg noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3655",null,"Antisperm antibodies test",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S3844",null,"Dna analysis deafness",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S3849",null,"Gene test niemann-pick",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S4011",null,"Ivf package",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S4020",null,"Ivf canc a aspir case rate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S4040",null,"Monit store cryo embryo 30 d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
["S4995",null,"Smoking cessation gum",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5035",null,"Hit routine device maint",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5130",null,"Homaker service nos per 15m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5146",null,"Ther fostercare child /month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5160",null,"Emer response sys instal&tst",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S5518",null,"Hit cath repair kit",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"]
["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,33.712913520000001,null,33.712913520000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9123",null,"Nursing care in home rn",null,67.788700581887994,null,67.788700581887994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9124",null,"Nursing care, in the home; b",null,48.965861520575999,null,48.965861520575999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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,45.545533203455996,null,45.545533203455996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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"]
["S9563",null,"Ht inj immuno 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,29.492056747296004,null,29.492056747296004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9982",null,"Med record copy per page",null,0.58476580905600006,null,0.58476580905600006,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"]
["T1032",null,"Sv doula brth wrk per 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1033",null,"Sv doula brth wrk 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,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4522",null,"Adult size brief/diaper med",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4523",null,"Adult size brief/diaper lg",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4524",null,"Adult size brief/diaper xl",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4525",null,"Adult size pull-on sm",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4526",null,"Adult size pull-on med",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4527",null,"Adult size pull-on lg",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4528",null,"Adult size pull-on xl",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["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,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4534",null,"Youth size pull-on",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4535",null,"Disposable liner/shield/pad",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4536",null,"Reusable pull-on any size",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4537",null,"Reusable underpad bed size",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["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,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4540",null,"Reusable underpad chair size",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4541",null,"Large disposable underpad",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4542",null,"Small disposable underpad",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["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,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["T4545",null,"Incon disposable penile wrap",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["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,51.006399999999999,null,51.006399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["U0002",null,"Covid-19 lab test non-cdc",null,72.860200000000006,null,72.860200000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["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,82.62,null,82.62,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2025",null,"Eyeglasses delux frames",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2100",null,"Lens spher single plano 4.00",null,52.193400000000004,null,52.193400000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2101",null,"Single visn sphere 4.12-7.00",null,53.672399999999996,null,53.672399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2102",null,"Singl visn sphere 7.12-20.00",null,67.656599999999997,null,67.656599999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2103",null,"Spherocylindr 4.00d/12-2.00d",null,49.572000000000003,null,49.572000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2104",null,"Spherocylindr 4.00d/2.12-4d",null,51.020400000000002,null,51.020400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2105",null,"Spherocylinder 4.00d/4.25-6d",null,57.558599999999998,null,57.558599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2106",null,"Spherocylinder 4.00d/>6.00d",null,61.750799999999998,null,61.750799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2107",null,"Spherocylinder 4.25d/12-2d",null,53.519399999999997,null,53.519399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2108",null,"Spherocylinder 4.25d/2.12-4d",null,52.224000000000004,null,52.224000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2109",null,"Spherocylinder 4.25d/4.25-6d",null,64.106999999999999,null,64.106999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2110",null,"Spherocylinder 4.25d/over 6d",null,57.007800000000003,null,57.007800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2111",null,"Spherocylindr 7.25d/.25-2.25",null,59.425199999999997,null,59.425199999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2112",null,"Spherocylindr 7.25d/2.25-4d",null,65.840999999999994,null,65.840999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2113",null,"Spherocylindr 7.25d/4.25-6d",null,77.764799999999994,null,77.764799999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2114",null,"Spherocylinder over 12.00d",null,84.731399999999994,null,84.731399999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2115",null,"Lens lenticular bifocal",null,102.32639999999999,null,102.32639999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2118",null,"Lens aniseikonic single",null,96.573600000000013,null,96.573600000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2121",null,"Lenticular lens, single",null,108.0894,null,108.0894,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"]
["V2200",null,"Lens spher bifoc plano 4.00d",null,74.266199999999998,null,74.266199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2201",null,"Lens sphere bifocal 4.12-7.0",null,74.561999999999998,null,74.561999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2202",null,"Lens sphere bifocal 7.12-20.",null,81.997799999999998,null,81.997799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2203",null,"Lens sphcyl bifocal 4.00d/.1",null,72.868799999999993,null,72.868799999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2204",null,"Lens sphcy bifocal 4.00d/2.1",null,73.225800000000007,null,73.225800000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2205",null,"Lens sphcy bifocal 4.00d/4.2",null,75.775800000000004,null,75.775800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2206",null,"Lens sphcy bifocal 4.00d/ove",null,76.367400000000004,null,76.367400000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2207",null,"Lens sphcy bifocal 4.25-7d/.",null,71.226600000000005,null,71.226600000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2208",null,"Lens sphcy bifocal 4.25-7/2.",null,69.880200000000002,null,69.880200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2209",null,"Lens sphcy bifocal 4.25-7/4.",null,80.661599999999993,null,80.661599999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2210",null,"Lens sphcy bifocal 4.25-7/ov",null,91.473600000000005,null,91.473600000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2211",null,"Lens sphcy bifo 7.25-12/.25-",null,99.878399999999999,null,99.878399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2212",null,"Lens sphcyl bifo 7.25-12/2.2",null,100.6332,null,100.6332,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2213",null,"Lens sphcyl bifo 7.25-12/4.2",null,96.910200000000003,null,96.910200000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2214",null,"Lens sphcyl bifocal over 12.",null,101.745,null,101.745,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2215",null,"Lens lenticular bifocal",null,122.2266,null,122.2266,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2218",null,"Lens aniseikonic bifocal",null,127.94880000000001,null,127.94880000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2219",null,"Lens bifocal seg width over",null,51.877200000000002,null,51.877200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2220",null,"Lens bifocal add over 3.25d",null,42.075000000000003,null,42.075000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2221",null,"Lenticular lens, bifocal",null,112.8732,null,112.8732,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"]
["V2300",null,"Lens sphere trifocal 4.00d",null,87.964799999999997,null,87.964799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2301",null,"Lens sphere trifocal 4.12-7.",null,92.432400000000001,null,92.432400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2302",null,"Lens sphere trifocal 7.12-20",null,95.553600000000003,null,95.553600000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2303",null,"Lens sphcy trifocal 4.0/.12-",null,87.414000000000001,null,87.414000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2304",null,"Lens sphcy trifocal 4.0/2.25",null,80.784000000000006,null,80.784000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2305",null,"Lens sphcy trifocal 4.0/4.25",null,91.034999999999997,null,91.034999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2306",null,"Lens sphcyl trifocal 4.00/>6",null,93.421800000000005,null,93.421800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2307",null,"Lens sphcy trifocal 4.25-7/.",null,94.992599999999996,null,94.992599999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2308",null,"Lens sphc trifocal 4.25-7/2.",null,105.3456,null,105.3456,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2309",null,"Lens sphc trifocal 4.25-7/4.",null,108.9156,null,108.9156,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2310",null,"Lens sphc trifocal 4.25-7/>6",null,103.9992,null,103.9992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2311",null,"Lens sphc trifo 7.25-12/.25-",null,103.8156,null,103.8156,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2312",null,"Lens sphc trifo 7.25-12/2.25",null,106.9164,null,106.9164,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2313",null,"Lens sphc trifo 7.25-12/4.25",null,119.92139999999999,null,119.92139999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2314",null,"Lens sphcyl trifocal over 12",null,125.23560000000001,null,125.23560000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2315",null,"Lens lenticular trifocal",null,141.75960000000001,null,141.75960000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2318",null,"Lens aniseikonic trifocal",null,170.9316,null,170.9316,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2319",null,"Lens trifocal seg width > 28",null,57.8748,null,57.8748,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2320",null,"Lens trifocal add over 3.25d",null,69.084600000000009,null,69.084600000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2321",null,"Lenticular lens, trifocal",null,137.0472,null,137.0472,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"]
["V2410",null,"Lens variab asphericity sing",null,123.62400000000001,null,123.62400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2430",null,"Lens variable asphericity bi",null,129.09120000000001,null,129.09120000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2499",null,"Variable asphericity lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2500",null,"Contact lens pmma spherical",null,126.276,null,126.276,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2501",null,"Cntct lens pmma-toric/prism",null,144.2688,null,144.2688,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2502",null,"Contact lens pmma bifocal",null,177.72480000000002,null,177.72480000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2503",null,"Cntct lens pmma color vision",null,174.6036,null,174.6036,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2510",null,"Cntct gas permeable sphericl",null,161.8638,null,161.8638,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2511",null,"Cntct toric prism ballast",null,185.77260000000001,null,185.77260000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2512",null,"Cntct lens gas permbl bifocl",null,219.50399999999999,null,219.50399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2513",null,"Contact lens extended wear",null,201.22560000000001,null,201.22560000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2520",null,"Contact lens hydrophilic",null,136.28220000000002,null,136.28220000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2521",null,"Cntct lens hydrophilic toric",null,211.57860000000002,null,211.57860000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2522",null,"Cntct lens hydrophil bifocl",null,205.9074,null,205.9074,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2523",null,"Cntct lens hydrophil extend",null,179.18339999999998,null,179.18339999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2524",null,"Cntct lens hydrophil photoch",null,157.44720000000001,null,157.44720000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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,259.88580000000002,null,259.88580000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2531",null,"Contact lens gas permeable",null,619.39499999999998,null,619.39499999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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"]
["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,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2624",null,"Polishing artifical eye",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2625",null,"Enlargemnt of eye prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2626",null,"Reduction of eye prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2627",null,"Scleral cover shell",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2628",null,"Fabrication & fitting",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["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,138.6996,null,138.6996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2631",null,"Iris support intraoclr lens",null,138.6996,null,138.6996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2632",null,"Post chmbr intraocular lens",null,138.6996,null,138.6996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2700",null,"Balance lens",null,51.050999999999995,null,51.050999999999995,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,74.715000000000003,null,74.715000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2715",null,"Prism lens/es",null,16.656599999999997,null,16.656599999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2718",null,"Fresnell prism press-on lens",null,33.272399999999998,null,33.272399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2730",null,"Special base curve",null,24.5718,null,24.5718,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2744",null,"Tint photochromatic lens/es",null,21.164999999999999,null,21.164999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2745",null,"Tint, any color/solid/grad",null,14.310599999999999,null,14.310599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2750",null,"Anti-reflective coating",null,22.236000000000001,null,22.236000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2755",null,"Uv lens/es",null,20.726400000000002,null,20.726400000000002,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,18.666,null,18.666,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,68.1768,null,68.1768,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2770",null,"Occluder lens/es",null,22.95,null,22.95,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2780",null,"Oversize lens/es",null,14.596200000000001,null,14.596200000000001,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,73.644000000000005,null,73.644000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2783",null,"Lens, >= 1.66 p/>=1.80 g",null,83.007599999999996,null,83.007599999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2784",null,"Lens polycarb or equal",null,53.988599999999998,null,53.988599999999998,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"]
["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"]
["V5008",null,"Hearing screening",null,91.717702551228101,null,91.717702551228101,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V5010",null,"Assessment for hearing aid",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["V5011",null,"Hearing aid fitting/checking",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["V5014",null,"Hearing aid repair/modifying",null,61.14888672976101,null,61.14888672976101,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V5020",null,"Conformity evaluation",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
["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"]
["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"]
["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"]
["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"]
["V5070",null,"Glasses air conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5080",null,"Glasses bone conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["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"]
["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"]
["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"]
["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"]
["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"]
["V5160",null,"Dispensing fee binaural",null,1736.5923668473672,null,1736.5923668473672,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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"]
["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"]
["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"]
["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"]
["V5200",null,"Disp fee contralateral monau",null,1040.870429738321,null,1040.870429738321,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["V5240",null,"Disp fee contralateral binau",null,1040.870429738321,null,1040.870429738321,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V5241",null,"Dispensing fee, monaural",null,868.2961834236836,null,868.2961834236836,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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"]
["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,1.0692332485417442,null,1.0692332485417442,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"]
["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":3,"n_rows":21,"n_cols":4,"rows_kept":21,"cut":false,"hidden":false,"merged":[[0,0,0,2],[4,3,5,5]]}
["Updates and Corrections"]
["Posting date","Policy Area","Description"]
[]
[]
[null,null,null,"It may take up to 20 seconds for this page to fully load."]
["Posting date","Description","Updated Version"]
["2023-06-15","Effective May 11, 2023 C9803 is deleted.","N/A"]
["2023-06-15","New HCPCS and deleted HCPCS codes","July 2023 Adds and Deletes​"]
[]
[]
["Posting date","Policy Area","Description"]
[]
[]
[]
["Posting date","Description","Updated Version"]
[]
[]
[]
["Posting date","Policy Area","Description"]
["2022-12-01","Temporary IME Telehealth Policy","The Temporary IME Telehealth Policy ​ allows temporary coverage for independent medical examiners to complete exams via telehealth. This policy is effective 1/1/2023 and expires 6/30/2023. This is an emerging situation, and this policy may be updated as needed. ​"]
["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.​ ​"]

{"sheet":"Chapters Inclusion","index":4,"n_rows":20538,"n_cols":22,"rows_kept":4500,"cut":true,"hidden":true,"merged":[[0,0,0,8],[1,0,1,8],[4,3,4,4],[4,6,4,14]],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["Professional Services Fee Schedule"]
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[]
[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"]
[100,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[102,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[103,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[104,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[120,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[124,null,"See CPT",5,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[126,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[140,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[142,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[144,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[145,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[147,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[148,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[160,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[162,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[164,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[170,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[172,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[174,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[176,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[190,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[192,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[210,null,"See CPT",11,11,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[211,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[212,null,"See CPT",0,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[214,null,"See CPT",9,9,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[215,null,"See CPT",9,9,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[216,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[218,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[220,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[222,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[300,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[320,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[322,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[326,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[350,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[352,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[400,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[402,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[404,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[406,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[410,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[450,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[454,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[470,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[472,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[474,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[500,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[520,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[522,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[524,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[528,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[529,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[530,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[532,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[534,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[537,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[539,null,"See CPT",18,18,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[540,null,"See CPT",12,12,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[541,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[542,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[546,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[548,null,"See CPT",17,17,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[550,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[560,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[561,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[562,null,"See CPT",20,20,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[563,null,"See CPT",25,25,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[566,null,"See CPT",25,25,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[567,null,"See CPT",18,18,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[580,null,"See CPT",20,20,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[600,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[604,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[620,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[625,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[626,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[630,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[632,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[635,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[640,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[670,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[700,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[702,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[730,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[731,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[732,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[750,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[752,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[754,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[756,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[770,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[790,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[792,null,"See CPT",13,13,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[794,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[796,null,"See CPT",30,30,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[797,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[800,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[802,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[811,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[812,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[813,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[820,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[830,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[832,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[834,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[836,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[840,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[842,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[844,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[846,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[848,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[851,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,4]
[860,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[862,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[864,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[865,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[866,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[868,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[870,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[872,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[873,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[880,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[882,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[902,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[904,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[906,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[908,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[910,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[912,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[914,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[916,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[918,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[920,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[921,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[922,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[924,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[926,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[928,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[930,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[932,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[934,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[936,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[938,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[940,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[942,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[944,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[948,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[950,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[952,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1112,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1120,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1130,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1140,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1150,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1160,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1170,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1173,null,"See CPT",12,12,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1200,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1202,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1210,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1212,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1214,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1215,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1220,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1230,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1232,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1234,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1250,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1260,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1270,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1272,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1274,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1320,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1340,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1360,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1380,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1382,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1390,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1392,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1400,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1402,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1404,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1420,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1430,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1432,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1440,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1442,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1444,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1462,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1464,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1470,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1472,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1474,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1480,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1482,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1484,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1486,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1490,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1500,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1502,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1520,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1522,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1610,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1620,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1622,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1630,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1634,null,"See CPT",9,9,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1636,null,"See CPT",15,15,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1638,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1650,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1652,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1654,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1656,null,"See CPT",10,10,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1670,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1680,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1710,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1712,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1714,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1716,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1730,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1732,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1740,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1742,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1744,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1756,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1758,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1760,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1770,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1772,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1780,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1782,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1810,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1820,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1829,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1830,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1832,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1840,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1842,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1844,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1850,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1852,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1860,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1916,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1920,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1922,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1924,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1925,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1926,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1930,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1931,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1932,null,"See CPT",6,6,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1933,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1937,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1938,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1939,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1940,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1941,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1942,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1951,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1952,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1953,null,"See CPT",57.45,57.45,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,4]
[1958,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1960,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1961,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1962,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1963,null,"See CPT",8,8,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1965,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1966,null,"See CPT",4,4,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1967,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1968,null,"See CPT",2,2,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1969,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1990,null,"See CPT",7,7,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1991,null,"See CPT",3,3,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1992,null,"See CPT",5,5,"000",0,0,0,9,9,9,9,9,9,null,"A",null,null,2,4]
[1996,null,"See CPT",76.153199999999998,76.153199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,4]
[1999,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,4]
[10004,null,"See CPT",92.287000000000006,75.615799999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10005,null,"See CPT",252.4496,131.58339999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10006,null,"See CPT",109.5536,89.31,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10007,null,"See CPT",560.86680000000001,157.78100000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10008,null,"See CPT",269.12079999999997,91.691599999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10009,null,"See CPT",825.81979999999999,194.10039999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10010,null,"See CPT",450.12239999999997,126.2248,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10011,null,"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,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[10030,null,"See CPT",1236.0504000000001,239.9462,"000",0,0,0,9,2,9,0,0,0,null,"R",null,"Y-CM",2,29]
[10035,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[10036,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,29]
[10040,null,"See CPT",218.51179999999999,93.477800000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10060,null,"See CPT",234.58759999999998,194.69579999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10061,null,"See CPT",394.15480000000002,336.40100000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10080,null,"See CPT",478.70159999999993,192.3142,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10081,null,"See CPT",647.19979999999998,310.20339999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10120,null,"See CPT",284.00579999999997,194.10039999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10121,null,"See CPT",491.80039999999997,334.01940000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10140,null,"See CPT",315.56200000000001,215.53479999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10160,null,"See CPT",242.32780000000002,176.8338,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10180,null,"See CPT",490.01420000000002,325.08839999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11000,null,"See CPT",107.76739999999999,48.227400000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11001,null,"See CPT",50.608999999999995,26.197600000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11004,null,"See CPT",1000.8673999999999,1000.8673999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11005,null,"See CPT",1356.9166,1356.9166,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11006,null,"See CPT",1231.2872,1231.2872,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11008,null,"See CPT",478.10619999999994,478.10619999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11010,null,"See CPT",843.68179999999995,498.94520000000006,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R",null,null,2,29]
[11011,null,"See CPT",922.87,528.7152000000001,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11012,null,"See CPT",1205.0895999999998,743.05920000000003,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11042,null,"See CPT",241.73239999999998,107.76739999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11043,null,"See CPT",427.49719999999996,274.4794,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11044,null,"See CPT",567.4162,400.70420000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11045,null,"See CPT",73.234200000000001,44.655000000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11046,null,"See CPT",132.17880000000002,96.454800000000006,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11047,null,"See CPT",217.91640000000001,170.87980000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11055,null,"See CPT",135.75119999999998,27.983799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11056,null,"See CPT",155.9948,39.296399999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11057,null,"See CPT",169.68899999999999,50.608999999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11102,null,"See CPT",191.71880000000002,67.875599999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11103,null,"See CPT",94.668599999999998,38.701000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11104,null,"See CPT",237.56460000000001,84.54679999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11105,null,"See CPT",111.33980000000001,45.845799999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11106,null,"See CPT",294.12760000000003,101.21799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11107,null,"See CPT",134.56039999999999,55.372199999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11200,null,"See CPT",170.87980000000002,141.70519999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11201,null,"See CPT",33.342400000000005,29.77,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11300,null,"See CPT",192.3142,61.3262,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11301,null,"See CPT",230.41980000000001,92.287000000000006,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11302,null,"See CPT",258.99899999999997,107.76739999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11303,null,"See CPT",286.38739999999996,127.41560000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11305,null,"See CPT",200.05439999999999,66.68480000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11306,null,"See CPT",232.20599999999999,88.119199999999992,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11307,null,"See CPT",261.976,112.53059999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11308,null,"See CPT",275.07479999999998,125.03400000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11310,null,"See CPT",220.298,82.165199999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11311,null,"See CPT",257.8082,113.12599999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11312,null,"See CPT",294.12760000000003,135.1558,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11313,null,"See CPT",339.97339999999997,172.07060000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11400,null,"See CPT",241.73239999999998,155.39939999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11401,null,"See CPT",293.53219999999999,195.29119999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11402,null,"See CPT",322.1114,212.55779999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11403,null,"See CPT",369.14800000000002,273.88399999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11404,null,"See CPT",418.56619999999998,300.67699999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11406,null,"See CPT",588.85059999999999,450.12239999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11420,null,"See CPT",239.9462,151.23159999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11421,null,"See CPT",300.08159999999998,201.24519999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11422,null,"See CPT",335.80559999999997,249.47260000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11423,null,"See CPT",381.65140000000002,286.38739999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11424,null,"See CPT",438.21440000000001,326.2792,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11426,null,"See CPT",608.49880000000007,488.82340000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11440,null,"See CPT",270.90699999999998,197.6728,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11441,null,"See CPT",326.2792,245.3048,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11442,null,"See CPT",362.00319999999999,270.3116,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11443,null,"See CPT",425.11559999999997,327.46999999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11444,null,"See CPT",525.14279999999997,411.42140000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11446,null,"See CPT",705.54899999999998,573.96559999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11450,null,"See CPT",810.33939999999996,478.70159999999993,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11451,null,"See CPT",987.17319999999984,604.92639999999994,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11462,null,"See CPT",785.33259999999996,454.29019999999997,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11463,null,"See CPT",1001.4628,609.0942,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11470,null,"See CPT",857.37599999999998,525.73820000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11471,null,"See CPT",1011.5845999999999,637.67340000000002,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[11600,null,"See CPT",370.93420000000003,223.27500000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11601,null,"See CPT",428.0926,270.90699999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11602,null,"See CPT",457.86260000000004,294.12760000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11603,null,"See CPT",520.37959999999998,351.286,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11604,null,"See CPT",578.72879999999998,385.81920000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11606,null,"See CPT",826.41520000000003,568.60700000000008,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11620,null,"See CPT",372.72039999999998,224.4658,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11621,null,"See CPT",430.4742,272.09780000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11622,null,"See CPT",472.74760000000003,308.41719999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11623,null,"See CPT",550.745,380.4606,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11624,null,"See CPT",625.7654,430.4742,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11626,null,"See CPT",751.39479999999992,525.14279999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11640,null,"See CPT",381.65140000000002,231.61060000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11641,null,"See CPT",444.16840000000002,283.41039999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11642,null,"See CPT",500.13600000000002,330.447,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11643,null,"See CPT",585.27819999999997,411.42140000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11644,null,"See CPT",719.83859999999993,509.06700000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11646,null,"See CPT",930.01479999999992,701.38119999999992,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11719,null,"See CPT",26.197600000000001,13.098800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11720,null,"See CPT",60.730800000000002,25.6022,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11721,null,"See CPT",82.165199999999999,42.273399999999995,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11730,null,"See CPT",215.53479999999999,96.454800000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11732,null,"See CPT",61.921599999999998,30.365400000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11740,null,"See CPT",107.76739999999999,58.944600000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11750,null,"See CPT",297.7,183.9786,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11755,null,"See CPT",229.22900000000001,108.36280000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11760,null,"See CPT",350.69059999999996,201.84059999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11762,null,"See CPT",536.45539999999994,339.97339999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11765,null,"See CPT",311.39420000000001,169.68899999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11770,null,"See CPT",667.4434,335.80559999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11771,null,"See CPT",1168.1748,817.48419999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11772,null,"See CPT",1437.2955999999999,1059.2166,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11900,null,"See CPT",106.5766,54.181400000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11901,null,"See CPT",129.7972,82.165199999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11920,null,"See CPT",359.6216,197.07740000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11921,null,"See CPT",417.37539999999996,236.9692,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11922,null,"See CPT",113.72139999999999,52.395200000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11950,null,"See CPT",151.23159999999999,94.0732,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11951,null,"See CPT",199.459,130.988,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11952,null,"See CPT",266.1438,183.38319999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11954,null,"See CPT",292.93680000000001,200.6498,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11960,null,"See CPT",1870.1514,1870.1514,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11970,null,"See CPT",1027.6604,1027.6604,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11971,null,"See CPT",1011.5845999999999,1011.5845999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11976,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[11980,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[11981,null,"See CPT",185.1694,111.33980000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11982,null,"See CPT",206.60380000000001,131.58339999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11983,null,"See CPT",260.18979999999999,184.57400000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12001,null,"See CPT",175.643,79.783600000000007,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12002,null,"See CPT",211.36699999999999,104.19499999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12004,null,"See CPT",244.70940000000002,129.20179999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12005,null,"See CPT",326.87459999999999,166.11660000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12006,null,"See CPT",378.67439999999999,204.8176,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12007,null,"See CPT",425.11559999999997,254.83120000000002,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[12011,null,"See CPT",209.58080000000001,97.645599999999988,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12013,null,"See CPT",217.91640000000001,102.4088,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12014,null,"See CPT",264.95300000000003,130.988,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12015,null,"See CPT",317.9436,165.52119999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12016,null,"See CPT",404.27659999999997,224.4658,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12017,null,"See CPT",269.71620000000001,269.71620000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12018,null,"See CPT",304.24940000000004,304.24940000000004,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[12020,null,"See CPT",561.46219999999994,342.9504,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12021,null,"See CPT",328.66079999999999,257.8082,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12031,null,"See CPT",497.15899999999999,277.45640000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12032,null,"See CPT",570.98860000000002,347.1182,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12034,null,"See CPT",626.36079999999993,373.31579999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12035,null,"See CPT",726.98340000000007,436.4282,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12036,null,"See CPT",802.5992,506.68539999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12037,null,"See CPT",896.67240000000004,588.25520000000006,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R",null,null,2,29]
[12041,null,"See CPT",498.34979999999996,264.35760000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12042,null,"See CPT",581.11040000000003,356.04920000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12044,null,"See CPT",716.86159999999995,387.60539999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12045,null,"See CPT",774.61540000000002,499.54060000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12046,null,"See CPT",929.4194,573.37020000000007,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12047,null,"See CPT",1016.3478,635.88720000000001,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[12051,null,"See CPT",534.07380000000001,309.01260000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12052,null,"See CPT",592.423,363.19399999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12053,null,"See CPT",684.1146,391.17779999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12054,null,"See CPT",721.02940000000001,396.53640000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12055,null,"See CPT",949.6629999999999,541.81399999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12056,null,"See CPT",1083.6279999999999,698.99959999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12057,null,"See CPT",1135.4277999999999,760.32579999999996,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[13100,null,"See CPT",640.65039999999999,363.7894,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13101,null,"See CPT",746.03620000000001,450.12239999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13102,null,"See CPT",216.72560000000001,128.011,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13120,null,"See CPT",667.4434,422.73399999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13121,null,"See CPT",797.24059999999997,466.19819999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13122,null,"See CPT",235.7784,147.6592,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13131,null,"See CPT",726.98340000000007,437.61899999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13132,null,"See CPT",880.59659999999997,547.76799999999992,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13133,null,"See CPT",309.608,223.87039999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13151,null,"See CPT",790.69119999999998,503.11299999999994,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13152,null,"See CPT",926.44240000000002,606.11720000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13153,null,"See CPT",341.16419999999999,244.70940000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13160,null,"See CPT",1442.0588,1442.0588,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14000,null,"See CPT",1179.4874,920.48840000000007,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14001,null,"See CPT",1497.4309999999998,1187.8229999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14020,null,"See CPT",1305.1168,1035.9959999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14021,null,"See CPT",1602.8168000000001,1291.4226000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14040,null,"See CPT",1406.3348000000001,1137.2140000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14041,null,"See CPT",1705.2256,1387.8773999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14060,null,"See CPT",1418.8381999999999,1213.4251999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14061,null,"See CPT",1839.1905999999999,1490.2862,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14301,null,"See CPT",1999.9486000000002,1576.0237999999999,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[14302,null,"See CPT",384.6284,384.6284,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[14350,null,"See CPT",1227.7148,1227.7148,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15002,null,"See CPT",638.86419999999998,391.77319999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15003,null,"See CPT",127.41560000000001,79.783600000000007,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15004,null,"See CPT",728.76959999999997,466.19819999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15005,null,"See CPT",211.36699999999999,158.37640000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15040,null,"See CPT",493.58659999999992,222.08420000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15050,null,"See CPT",1105.0623999999998,848.44499999999994,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15100,null,"See CPT",1601.626,1300.9490000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15101,null,"See CPT",345.92739999999998,198.26820000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15110,null,"See CPT",1524.2240000000002,1289.0409999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15111,null,"See CPT",201.24519999999998,180.40619999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15115,null,"See CPT",1466.4702,1244.9813999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15116,null,"See CPT",276.86099999999999,246.49559999999997,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15120,null,"See CPT",1558.1618000000001,1252.1262000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15121,null,"See CPT",387.60539999999997,239.9462,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15130,null,"See CPT",1338.4592,1092.559,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15131,null,"See CPT",175.643,160.1626,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15135,null,"See CPT",1619.4879999999998,1382.5187999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15136,null,"See CPT",173.26140000000001,160.1626,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15150,null,"See CPT",1281.8962000000001,1150.3127999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15151,null,"See CPT",210.17619999999999,191.71880000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15152,null,"See CPT",268.52539999999999,250.06800000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15155,null,"See CPT",1460.5162,1327.742,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15156,null,"See CPT",281.62420000000003,263.16679999999997,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15157,null,"See CPT",314.37119999999999,286.9828,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15200,null,"See CPT",1548.6354000000001,1222.9515999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15201,null,"See CPT",261.976,136.3466,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15220,null,"See CPT",1427.1737999999998,1113.3979999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15221,null,"See CPT",242.32780000000002,122.6524,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15240,null,"See CPT",1718.9198000000001,1453.3714,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15241,null,"See CPT",320.92059999999998,188.1464,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15260,null,"See CPT",1846.9307999999999,1543.2768000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15261,null,"See CPT",381.05600000000004,244.11399999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15271,null,"See CPT",285.79199999999997,148.85,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15272,null,"See CPT",44.059599999999996,29.77,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15273,null,"See CPT",573.37020000000007,347.1182,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15274,null,"See CPT",153.01779999999999,79.188200000000009,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15275,null,"See CPT",294.12760000000003,166.11660000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15276,null,"See CPT",58.944600000000001,44.059599999999996,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15277,null,"See CPT",635.88720000000001,398.91800000000001,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[15278,null,"See CPT",176.23839999999998,98.836399999999998,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15570,null,"See CPT",1675.4556,1327.1466,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15572,null,"See CPT",1625.442,1342.0316,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15574,null,"See CPT",1616.511,1337.8637999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15576,null,"See CPT",1445.0357999999999,1183.0598,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15600,null,"See CPT",639.45960000000002,392.964,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15610,null,"See CPT",693.64099999999996,452.50399999999996,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15620,null,"See CPT",838.91859999999997,602.5447999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15630,null,"See CPT",865.11619999999994,632.91020000000003,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15650,null,"See CPT",1010.3937999999999,741.27299999999991,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15730,null,"See CPT",2665.0103999999997,1667.12,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15731,null,"See CPT",2066.6334000000002,1817.7562,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15733,null,"See CPT",1868.3652,1868.3652,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15734,null,"See CPT",2700.7343999999998,2700.7343999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15736,null,"See CPT",2208.3386,2208.3386,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15738,null,"See CPT",2294.6716000000001,2294.6716000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15740,null,"See CPT",1866.579,1533.155,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15750,null,"See CPT",1681.4096,1681.4096,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15756,null,"See CPT",4127.3127999999997,4127.3127999999997,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15757,null,"See CPT",4105.2830000000004,4105.2830000000004,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15758,null,"See CPT",4091.5888,4091.5888,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15760,null,"See CPT",1565.902,1277.7284,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15769,null,"See CPT",875.83339999999998,875.83339999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[15770,null,"See CPT",1231.8826000000001,1231.8826000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15771,null,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[15773,null,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[15775,null,"See CPT",698.99959999999999,459.05340000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15776,null,"See CPT",942.51819999999998,626.95619999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15777,null,"See CPT",382.84219999999999,382.84219999999999,"000",0,0,0,0,0,1,1,0,0,null,"R",null,null,2,29]
[15778,null,"See CPT",679.94679999999994,679.94679999999994,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[15780,null,"See CPT",1576.0237999999999,1215.8068000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15781,null,"See CPT",1006.2259999999999,789.50040000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15782,null,"See CPT",907.98500000000001,679.94679999999994,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15783,null,"See CPT",838.32320000000004,651.96299999999997,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15786,null,"See CPT",431.06959999999998,244.70940000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[15787,null,"See CPT",55.967599999999997,29.77,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15788,null,"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,"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,"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,"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,"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,"See CPT",1074.1016,949.06759999999997,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15821,null,"See CPT",1148.5265999999999,1010.9892,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15822,null,"See CPT",860.35299999999995,736.50979999999993,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15823,null,"See CPT",1152.0990000000002,1013.3707999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15824,null,"See CPT",1608.0177083667843,1608.0177083667843,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15825,null,"See CPT",1382.618072268576,1382.618072268576,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15826,null,"See CPT",1307.4701491463043,1307.4701491463043,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15828,null,"See CPT",4478.4344653139533,4478.4344653139533,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15829,null,"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,"See CPT",2124.3872000000001,2124.3872000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[15832,null,"See CPT",1679.6233999999999,1679.6233999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[15833,null,"See CPT",1602.2213999999999,1602.2213999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15834,null,"See CPT",1630.2051999999999,1630.2051999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15835,null,"See CPT",1696.8899999999999,1696.8899999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15836,null,"See CPT",1458.1345999999999,1458.1345999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15837,null,"See CPT",1604.0076000000001,1311.0708,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15838,null,"See CPT",1191.3954000000001,1191.3954000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15839,null,"See CPT",1643.8994,1347.3901999999998,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15840,null,"See CPT",1845.74,1845.74,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15841,null,"See CPT",3227.6633999999999,3227.6633999999999,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15842,null,"See CPT",4875.1351999999997,4875.1351999999997,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15845,null,"See CPT",1936.8362,1936.8362,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15847,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,2,1,0,null,"N",null,"Y-CM",2,29]
[15851,null,"See CPT",102.4088,117.29379999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15852,null,"See CPT",81.569800000000001,81.569800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15853,null,"See CPT",21.4344,21.4344,"000",0,0,0,5,2,0,1,0,0,null,"R",null,null,2,29]
[15854,null,"See CPT",30.365400000000001,30.365400000000001,"000",0,0,0,5,2,0,1,0,0,null,"R",null,null,2,29]
[15860,null,"See CPT",188.74179999999998,188.74179999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15876,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[15877,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[15878,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[15879,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[15920,null,"See CPT",1171.1518000000001,1171.1518000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15922,null,"See CPT",1462.3023999999998,1462.3023999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15931,null,"See CPT",1278.9192,1278.9192,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15933,null,"See CPT",1586.1456000000001,1586.1456000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15934,null,"See CPT",1721.8968,1721.8968,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15935,null,"See CPT",2110.6930000000002,2110.6930000000002,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15936,null,"See CPT",1634.9684,1634.9684,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15937,null,"See CPT",1896.3490000000002,1896.3490000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15940,null,"See CPT",1287.2547999999999,1287.2547999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15941,null,"See CPT",1711.7749999999999,1711.7749999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15944,null,"See CPT",1711.1795999999999,1711.1795999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15945,null,"See CPT",1865.3881999999999,1865.3881999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15946,null,"See CPT",2929.3679999999999,2929.3679999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15950,null,"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15951,null,"See CPT",1649.258,1649.258,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R",null,null,2,29]
[15952,null,"See CPT",1676.0509999999999,1676.0509999999999,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15953,null,"See CPT",1846.3354000000002,1846.3354000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15956,null,"See CPT",2113.67,2113.67,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15958,null,"See CPT",2146.4169999999999,2146.4169999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15999,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[16000,null,"See CPT",144.68219999999999,81.569800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16020,null,"See CPT",159.56720000000001,101.21799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16025,null,"See CPT",288.76899999999995,198.86359999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16030,null,"See CPT",363.19399999999996,235.7784,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16035,null,"See CPT",345.92739999999998,345.92739999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16036,null,"See CPT",145.87300000000002,145.87300000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[17000,null,"See CPT",125.62939999999999,101.21799999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17003,null,"See CPT",12.503399999999999,3.5724,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17004,null,"See CPT",317.34820000000002,181.0016,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17106,null,"See CPT",638.26880000000006,505.49459999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17107,null,"See CPT",827.60599999999999,655.53539999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17108,null,"See CPT",1167.5793999999999,957.40319999999986,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[17110,null,"See CPT",214.93939999999998,124.43859999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17111,null,"See CPT",250.06800000000001,151.827,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17250,null,"See CPT",165.52119999999999,67.875599999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[17260,null,"See CPT",186.9556,129.20179999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17261,null,"See CPT",278.05180000000001,158.37640000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17262,null,"See CPT",334.6148,201.24519999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17263,null,"See CPT",361.40780000000001,222.08420000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17264,null,"See CPT",387.01,236.37380000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17266,null,"See CPT",440.00059999999996,278.6472,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17270,null,"See CPT",280.43340000000001,173.85679999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17271,null,"See CPT",311.9896,191.71880000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17272,null,"See CPT",353.07219999999995,220.298,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17273,null,"See CPT",390.58239999999995,248.87719999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17274,null,"See CPT",456.07639999999998,304.24940000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17276,null,"See CPT",528.11979999999994,365.57559999999995,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17280,null,"See CPT",262.57139999999998,157.78100000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17281,null,"See CPT",336.40100000000001,214.93939999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17282,null,"See CPT",384.03300000000002,248.2818,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17283,null,"See CPT",451.90859999999998,308.41719999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17284,null,"See CPT",513.23479999999995,359.6216,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17286,null,"See CPT",653.74919999999997,484.65560000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17311,null,"See CPT",1268.7973999999999,639.45960000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17312,null,"See CPT",773.42460000000005,340.56879999999995,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17313,null,"See CPT",1193.1815999999999,572.77479999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17314,null,"See CPT",741.86840000000007,314.96659999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17315,null,"See CPT",146.4684,90.500799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17340,null,"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,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[17999,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[19000,null,"See CPT",191.1234,75.615799999999993,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19001,null,"See CPT",47.632000000000005,36.9148,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19020,null,"See CPT",879.4058,574.56100000000004,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[19030,null,"See CPT",309.608,136.3466,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19081,null,"See CPT",955.02159999999992,290.55520000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19082,null,"See CPT",746.03620000000001,146.4684,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19083,null,"See CPT",956.21239999999989,273.28859999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19084,null,"See CPT",735.31899999999996,138.13279999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19085,null,"See CPT",1476.5920000000001,318.53899999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19086,null,"See CPT",1153.8851999999999,160.1626,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19100,null,"See CPT",281.02879999999999,121.4616,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19101,null,"See CPT",611.47579999999994,404.87199999999996,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19105,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[19110,null,"See CPT",906.19880000000001,643.62739999999997,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19112,null,"See CPT",860.35299999999995,590.63679999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19120,null,"See CPT",953.83079999999995,756.75340000000006,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19125,null,"See CPT",1049.0948000000001,835.94159999999999,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19126,null,"See CPT",281.02879999999999,281.02879999999999,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM",2,29]
[19281,null,"See CPT",454.29019999999997,175.643,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19282,null,"See CPT",325.68379999999996,88.714600000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19283,null,"See CPT",491.80039999999997,176.8338,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19284,null,"See CPT",364.98019999999997,88.714600000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19285,null,"See CPT",710.31219999999996,150.63619999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19286,null,"See CPT",586.46899999999994,75.615799999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19287,null,"See CPT",1228.3101999999999,223.87039999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19288,null,"See CPT",955.02159999999992,112.53059999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19294,null,"See CPT",288.17359999999996,288.17359999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19296,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[19297,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,29]
[19298,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[19300,null,"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,"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,"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,"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,"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,"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,"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,"See CPT",1442.6541999999999,1442.6541999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19318,null,"See CPT",1985.6590000000001,1985.6590000000001,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19325,null,"See CPT",1126.4968000000001,1126.4968000000001,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19328,null,"See CPT",1013.9662000000001,1013.9662000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19330,null,"See CPT",1180.0827999999999,1180.0827999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19340,null,"See CPT",1386.0912000000001,1386.0912000000001,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19342,null,"See CPT",1390.259,1390.259,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM",2,29]
[19350,null,"See CPT",1537.3227999999999,1231.2872,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19355,null,"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,"See CPT",2122.6009999999997,2122.6009999999997,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19361,null,"See CPT",2822.1959999999999,2822.1959999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19364,null,"See CPT",4907.2867999999999,4907.2867999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19367,null,"See CPT",3205.6336000000001,3205.6336000000001,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19368,null,"See CPT",3917.732,3917.732,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19369,null,"See CPT",3641.4663999999998,3641.4663999999998,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19370,null,"See CPT",1226.5240000000001,1226.5240000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19371,null,"See CPT",1300.3535999999999,1300.3535999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19380,null,"See CPT",1474.2104000000002,1474.2104000000002,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19396,null,"See CPT",514.42560000000003,257.21280000000002,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19499,null,"See CPT","By Report","By Report","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[20100,null,"See CPT",1069.3384000000001,1069.3384000000001,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[20101,null,"See CPT",1099.7038,375.69739999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20102,null,"See CPT",1144.9541999999999,455.48099999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20103,null,"See CPT",1050.2855999999999,623.38380000000006,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20150,null,"See CPT",1820.1378,1820.1378,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[20200,null,"See CPT",409.6352,169.68899999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20205,null,"See CPT",567.4162,275.67019999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20206,null,"See CPT",426.90179999999998,103.0042,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20220,null,"See CPT",445.95460000000003,156.59019999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20225,null,"See CPT",731.1511999999999,230.41980000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20240,null,"See CPT",250.6634,250.6634,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20245,null,"See CPT",615.64359999999999,615.64359999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20250,null,"See CPT",704.95359999999994,704.95359999999994,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20251,null,"See CPT",763.30280000000005,763.30280000000005,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[20500,null,"See CPT",231.01519999999999,162.54419999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20501,null,"See CPT",273.88399999999996,64.898600000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20520,null,"See CPT",406.06280000000004,270.3116,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20525,null,"See CPT",874.04719999999998,449.52699999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20526,null,"See CPT",151.23159999999999,102.4088,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20527,null,"See CPT",161.35339999999999,118.4846,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20550,null,"See CPT",106.5766,69.661799999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20551,null,"See CPT",106.5766,69.661799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20552,null,"See CPT",97.645599999999988,66.68480000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20553,null,"See CPT",112.53059999999999,76.211200000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20555,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[20560,null,"See CPT",48.227400000000003,26.792999999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20561,null,"See CPT",69.661799999999999,39.891800000000003,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20600,null,"See CPT",97.645599999999988,63.707800000000006,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20604,null,"See CPT",152.42240000000001,82.165199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20605,null,"See CPT",101.8134,66.089400000000012,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20606,null,"See CPT",165.52119999999999,92.882400000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20610,null,"See CPT",118.4846,80.974400000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20611,null,"See CPT",184.57400000000001,107.172,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20612,null,"See CPT",118.4846,73.829599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20615,null,"See CPT",473.34300000000002,295.3184,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20650,null,"See CPT",421.54320000000001,299.4862,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,null,2,29]
[20660,null,"See CPT",425.71100000000001,425.71100000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20661,null,"See CPT",952.04459999999995,952.04459999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20662,null,"See CPT",962.16639999999995,962.16639999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20663,null,"See CPT",887.7414,887.7414,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[20664,null,"See CPT",1612.3431999999998,1612.3431999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20665,null,"See CPT",218.51179999999999,179.8108,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20670,null,"See CPT",678.75599999999997,266.1438,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20680,null,"See CPT",1118.7565999999999,765.08899999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20690,null,"See CPT",1085.4141999999999,1085.4141999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20692,null,"See CPT",2046.3897999999999,2046.3897999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20693,null,"See CPT",813.31640000000004,813.31640000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20694,null,"See CPT",803.19460000000004,629.33780000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20696,null,"See CPT",2128.5549999999998,2128.5549999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20697,null,"See CPT",3523.5771999999997,3523.5771999999997,"000",0,0,0,3,0,0,2,1,0,null,"R",null,null,2,29]
[20700,null,"See CPT",150.63619999999997,150.63619999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20701,null,"See CPT",114.9122,114.9122,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20702,null,"See CPT",253.04499999999999,253.04499999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20703,null,"See CPT",182.78779999999998,182.78779999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20704,null,"See CPT",261.38059999999996,261.38059999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20705,null,"See CPT",221.4888,221.4888,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20802,null,"See CPT",4931.1027999999997,4931.1027999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20805,null,"See CPT",5850.4004000000004,5850.4004000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20808,null,"See CPT",7047.7498000000005,7047.7498000000005,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20816,null,"See CPT",3692.6708000000003,3692.6708000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20822,null,"See CPT",3197.8933999999999,3197.8933999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20824,null,"See CPT",3699.8155999999999,3699.8155999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20827,null,"See CPT",3284.2263999999996,3284.2263999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20838,null,"See CPT",5009.6956,5009.6956,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20900,null,"See CPT",733.53279999999995,326.2792,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20902,null,"See CPT",494.18200000000002,494.18200000000002,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20910,null,"See CPT",880.59659999999997,880.59659999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20912,null,"See CPT",887.14599999999996,887.14599999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20920,null,"See CPT",737.10520000000008,737.10520000000008,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[20922,null,"See CPT",1119.9474,896.67240000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20924,null,"See CPT",927.63319999999999,927.63319999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20930,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[20931,null,"See CPT",194.10039999999998,194.10039999999998,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[20932,null,"See CPT",1340.2454,1340.2454,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20933,null,"See CPT",1230.6918000000001,1230.6918000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20934,null,"See CPT",1339.65,1339.65,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20936,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[20937,null,"See CPT",294.72300000000001,294.72300000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20938,null,"See CPT",321.51600000000002,321.51600000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20939,null,"See CPT",123.8432,123.8432,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR",2,29]
[20950,null,"See CPT",500.13600000000002,158.9718,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[20955,null,"See CPT",4446.4472000000005,4446.4472000000005,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20956,null,"See CPT",4742.3609999999999,4742.3609999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20957,null,"See CPT",4941.82,4941.82,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20962,null,"See CPT",4814.4044000000004,4814.4044000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20969,null,"See CPT",4903.1189999999997,4903.1189999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20970,null,"See CPT",5112.6998000000003,5112.6998000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20972,null,"See CPT",5097.8148000000001,5097.8148000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[20973,null,"See CPT",5381.2251999999999,5381.2251999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20974,null,"See CPT",153.61320000000001,92.287000000000006,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR",2,29]
[20975,null,"See CPT",313.77579999999995,313.77579999999995,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20979,null,"See CPT",104.19499999999999,57.753799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR",2,29]
[20982,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[20983,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[20985,null,"See CPT",257.21280000000002,257.21280000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20999,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[21010,null,"See CPT",1362.2751999999998,1362.2751999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21011,null,"See CPT",701.38119999999992,481.08319999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21012,null,"See CPT",621.59759999999994,621.59759999999994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21013,null,"See CPT",999.67659999999989,738.29600000000005,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21014,null,"See CPT",956.21239999999989,956.21239999999989,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21015,null,"See CPT",1276.5376000000001,1276.5376000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21016,null,"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,"See CPT",1459.3254000000002,1206.8758,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21026,null,"See CPT",993.72260000000006,786.52340000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21029,null,"See CPT",1428.3645999999999,1141.9772,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[21030,null,"See CPT",856.18520000000001,663.87099999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[21031,null,"See CPT",718.64779999999996,503.11299999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[21032,null,"See CPT",694.2364,479.29700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21034,null,"See CPT",2387.5540000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21040,null,"See CPT",868.09320000000002,669.2296,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21044,null,"See CPT",1576.6192000000001,1576.6192000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21045,null,"See CPT",2188.6904,2188.6904,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21046,null,"See CPT",1815.3745999999999,1815.3745999999999,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[21047,null,"See CPT",2209.5293999999999,2209.5293999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21048,null,"See CPT",1824.9009999999998,1824.9009999999998,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[21049,null,"See CPT",2089.2586000000001,2089.2586000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21050,null,"See CPT",1593.2904000000001,1593.2904000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21060,null,"See CPT",1442.6541999999999,1442.6541999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21070,null,"See CPT",1123.5198,1123.5198,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21073,null,"See CPT",703.16740000000004,443.57299999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21076,null,"See CPT",1573.6422,1271.7744,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21077,null,"See CPT",3854.0242000000003,3127.0408000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21079,null,"See CPT",2641.7898,2102.9528,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21080,null,"See CPT",3041.8986,2389.3402000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21081,null,"See CPT",2806.7156,2187.4996000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21082,null,"See CPT",2592.3715999999999,2000.5440000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21083,null,"See CPT",2479.2456000000002,1858.2434000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21084,null,"See CPT",2826.9591999999998,2147.6077999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21085,null,"See CPT",1242.5998,871.66560000000004,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21086,null,"See CPT",2868.0418,2305.9841999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21087,null,"See CPT",2868.0418,2305.9841999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21088,null,"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,"See CPT","By Report","By Report","000",0,0,0,0,0,0,1,1,1,null,"N",null,null,2,29]
[21100,null,"See CPT",1167.5793999999999,653.15380000000005,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21110,null,"See CPT",1633.1822,1348.5809999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21116,null,"See CPT",413.803,80.974400000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21120,null,"See CPT",1246.1722,944.30439999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[21121,null,"See CPT",1171.7472,972.28819999999985,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21122,null,"See CPT",1381.9234000000001,1381.9234000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21123,null,"See CPT",1564.1158,1564.1158,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21125,null,"See CPT",5008.5048000000006,1215.8068000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21127,null,"See CPT",7678.8737999999994,1393.8314,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21137,null,"See CPT",1373.5878,1373.5878,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21138,null,"See CPT",1667.7154,1667.7154,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21139,null,"See CPT",1991.0175999999999,1991.0175999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21141,null,"See CPT",2442.9261999999999,2442.9261999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21142,null,"See CPT",2506.0386000000003,2506.0386000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21143,null,"See CPT",2581.0590000000002,2581.0590000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21145,null,"See CPT",2832.3177999999998,2832.3177999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21146,null,"See CPT",2957.3517999999999,2957.3517999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21147,null,"See CPT",3112.1558,3112.1558,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21150,null,"See CPT",2992.4803999999999,2992.4803999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21151,null,"See CPT",3290.1803999999997,3290.1803999999997,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21154,null,"See CPT",3539.6530000000002,3539.6530000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21155,null,"See CPT",3921.3044,3921.3044,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21159,null,"See CPT",4691.7519999999995,4691.7519999999995,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21160,null,"See CPT",5084.7160000000003,5084.7160000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21172,null,"See CPT",3794.4841999999999,3794.4841999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21175,null,"See CPT",4000.4925999999996,4000.4925999999996,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21179,null,"See CPT",2756.7019999999998,2756.7019999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21180,null,"See CPT",3076.4317999999998,3076.4317999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21181,null,"See CPT",1354.5350000000001,1354.5350000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[21182,null,"See CPT",3821.8725999999997,3821.8725999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21183,null,"See CPT",4155.8919999999998,4155.8919999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21184,null,"See CPT",4466.6907999999994,4466.6907999999994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21188,null,"See CPT",2898.4072000000001,2898.4072000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21193,null,"See CPT",2251.8027999999999,2251.8027999999999,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[21194,null,"See CPT",2604.2796000000003,2604.2796000000003,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-UR",2,29]
[21195,null,"See CPT",2462.5744,2462.5744,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-UR",2,29]
[21196,null,"See CPT",2628.0956000000001,2628.0956000000001,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[21198,null,"See CPT",1867.1743999999999,1867.1743999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21199,null,"See CPT",1851.694,1851.694,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21206,null,"See CPT",1772.5057999999999,1772.5057999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21208,null,"See CPT",3106.2018000000003,1343.8178,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21209,null,"See CPT",1534.3458000000001,1147.3358000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21210,null,"See CPT",3339.0031999999997,1382.5187999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21215,null,"See CPT",7847.3720000000003,1434.3186000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21230,null,"See CPT",1365.8476000000001,1365.8476000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21235,null,"See CPT",1370.6107999999999,1047.904,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21240,null,"See CPT",1924.9281999999998,1924.9281999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21242,null,"See CPT",1857.6479999999999,1857.6479999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21243,null,"See CPT",3072.2640000000001,3072.2640000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21244,null,"See CPT",1854.0755999999999,1854.0755999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21245,null,"See CPT",2289.9083999999998,1744.5219999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21246,null,"See CPT",1554.5893999999998,1554.5893999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21247,null,"See CPT",2887.0945999999999,2887.0945999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21248,null,"See CPT",1809.4205999999999,1440.8679999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21249,null,"See CPT",2443.5216,2010.0703999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21255,null,"See CPT",2460.1927999999998,2460.1927999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21256,null,"See CPT",2255.3751999999999,2255.3751999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21260,null,"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,"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,"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,"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,"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,"See CPT",1880.8686,1363.4659999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21275,null,"See CPT",1540.2998,1540.2998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21280,null,"See CPT",1081.8418000000001,1081.8418000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21282,null,"See CPT",738.89139999999998,738.89139999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[21295,null,"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,"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,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[21315,null,"See CPT",285.79199999999997,108.95820000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21320,null,"See CPT",410.82600000000002,171.4752,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21325,null,"See CPT",835.34619999999995,835.34619999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21330,null,"See CPT",998.48579999999993,998.48579999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21335,null,"See CPT",1323.5742,1323.5742,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21336,null,"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21337,null,"See CPT",787.71420000000001,559.0806,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21338,null,"See CPT",1256.2940000000001,1256.2940000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21339,null,"See CPT",1414.6704,1414.6704,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21340,null,"See CPT",1378.3509999999999,1378.3509999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21343,null,"See CPT",2008.8796,2008.8796,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21344,null,"See CPT",2548.3119999999999,2548.3119999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21345,null,"See CPT",1494.454,1177.1058,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21346,null,"See CPT",1908.8524000000002,1908.8524000000002,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21347,null,"See CPT",1920.7603999999999,1920.7603999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21348,null,"See CPT",1993.9946,1993.9946,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21355,null,"See CPT",840.10939999999994,607.30799999999999,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21356,null,"See CPT",1019.3248000000001,744.25,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21360,null,"See CPT",966.92959999999994,966.92959999999994,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21365,null,"See CPT",1971.9647999999997,1971.9647999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21366,null,"See CPT",2319.6784000000002,2319.6784000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21385,null,"See CPT",1345.0085999999999,1345.0085999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21386,null,"See CPT",1264.0342000000001,1264.0342000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21387,null,"See CPT",1402.7623999999998,1402.7623999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21390,null,"See CPT",1472.4241999999999,1472.4241999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21395,null,"See CPT",1834.4273999999998,1834.4273999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21400,null,"See CPT",404.87199999999996,313.77579999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21401,null,"See CPT",960.38019999999995,609.0942,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21406,null,"See CPT",1072.9107999999999,1072.9107999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21407,null,"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21408,null,"See CPT",1646.8763999999999,1646.8763999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21421,null,"See CPT",1206.2804000000001,1013.9662000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21422,null,"See CPT",1155.6713999999999,1155.6713999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21423,null,"See CPT",1459.9207999999999,1459.9207999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21431,null,"See CPT",1290.8271999999999,1290.8271999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21432,null,"See CPT",1318.2156,1318.2156,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21433,null,"See CPT",3138.9487999999997,3138.9487999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21435,null,"See CPT",2559.0291999999999,2559.0291999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21436,null,"See CPT",3690.8845999999999,3690.8845999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21440,null,"See CPT",1309.2846,1047.904,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21445,null,"See CPT",1481.9506000000001,1190.8,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21450,null,"See CPT",1121.7336,907.38959999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21451,null,"See CPT",1453.3714,1207.4712,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21452,null,"See CPT",1428.3645999999999,882.97820000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21453,null,"See CPT",2073.7781999999997,1758.2162000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21454,null,"See CPT",893.1,893.1,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[21461,null,"See CPT",3484.2808,1983.8728000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21462,null,"See CPT",3765.9049999999997,2186.9041999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21465,null,"See CPT",1450.3943999999999,1450.3943999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21470,null,"See CPT",2114.8608000000004,2114.8608000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21480,null,"See CPT",270.3116,55.372199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21485,null,"See CPT",1849.3123999999998,1504.5757999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21490,null,"See CPT",1428.96,1428.96,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21497,null,"See CPT",1342.627,1111.6118000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21499,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[21501,null,"See CPT",915.12979999999993,618.62060000000008,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21502,null,"See CPT",914.53440000000001,914.53440000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21510,null,"See CPT",820.46119999999996,820.46119999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21550,null,"See CPT",502.51759999999996,286.38739999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21552,null,"See CPT",811.53020000000004,811.53020000000004,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21554,null,"See CPT",1324.1695999999999,1324.1695999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21555,null,"See CPT",811.53020000000004,563.84379999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21556,null,"See CPT",969.3112000000001,969.3112000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21557,null,"See CPT",1723.683,1723.683,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21558,null,"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,"See CPT",1033.6143999999999,1033.6143999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21601,null,"See CPT",2044.0081999999998,2044.0081999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21602,null,"See CPT",2769.2053999999998,2769.2053999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21603,null,"See CPT",3009.7469999999998,3009.7469999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21610,null,"See CPT",2039.8403999999998,2039.8403999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21615,null,"See CPT",1104.4670000000001,1104.4670000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21616,null,"See CPT",1253.9123999999999,1253.9123999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21620,null,"See CPT",912.15279999999996,912.15279999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21627,null,"See CPT",991.93640000000005,991.93640000000005,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21630,null,"See CPT",2387.5540000000001,2387.5540000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21632,null,"See CPT",2153.5617999999999,2153.5617999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21685,null,"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,"See CPT",626.36079999999993,626.36079999999993,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21705,null,"See CPT",931.2056,931.2056,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21720,null,"See CPT",971.69280000000003,971.69280000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21725,null,"See CPT",998.48579999999993,998.48579999999993,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21740,null,"See CPT",1808.8252,1808.8252,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21742,null,"See CPT","By Report ","By Report ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-UR",2,29]
[21743,null,"See CPT","By Report ","By Report ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-UR",2,29]
[21750,null,"See CPT",1199.1356000000001,1199.1356000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21811,null,"See CPT",1042.5454,1042.5454,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21812,null,"See CPT",1264.6296,1264.6296,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21813,null,"See CPT",1724.8737999999998,1724.8737999999998,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21820,null,"See CPT",284.60120000000001,280.43340000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21825,null,"See CPT",996.10419999999999,996.10419999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21899,null,"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,"See CPT",482.27399999999994,284.00579999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21925,null,"See CPT",920.48840000000007,694.2364,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21930,null,"See CPT",934.77799999999991,665.06179999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21931,null,"See CPT",850.82659999999998,850.82659999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21932,null,"See CPT",1205.0895999999998,1205.0895999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21933,null,"See CPT",1334.2914000000001,1334.2914000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21935,null,"See CPT",1835.6181999999999,1835.6181999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[21936,null,"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,"See CPT",1754.0484000000001,1754.0484000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[22015,null,"See CPT",1727.2554,1727.2554,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[22100,null,"See CPT",1570.0698,1570.0698,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22101,null,"See CPT",1581.9777999999999,1581.9777999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22102,null,"See CPT",1417.0520000000001,1417.0520000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22103,null,"See CPT",238.75539999999998,238.75539999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22110,null,"See CPT",1920.165,1920.165,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22112,null,"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22114,null,"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22116,null,"See CPT",247.68639999999999,247.68639999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22206,null,"See CPT",4366.0681999999997,4366.0681999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22207,null,"See CPT",4286.88,4286.88,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22208,null,"See CPT",1032.4236000000001,1032.4236000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22210,null,"See CPT",3210.3968,3210.3968,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22212,null,"See CPT",2731.6952000000001,2731.6952000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22214,null,"See CPT",2731.6952000000001,2731.6952000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22216,null,"See CPT",638.26880000000006,638.26880000000006,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22220,null,"See CPT",2918.0553999999997,2918.0553999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22222,null,"See CPT",3161.5740000000001,3161.5740000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22224,null,"See CPT",2859.7062000000001,2859.7062000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22226,null,"See CPT",632.31479999999999,632.31479999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22310,null,"See CPT",577.5379999999999,550.745,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[22315,null,"See CPT",1634.9684,1412.8842,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[22318,null,"See CPT",2957.9472000000001,2957.9472000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22319,null,"See CPT",3275.2954,3275.2954,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22325,null,"See CPT",2660.8425999999999,2660.8425999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22326,null,"See CPT",2717.4056,2717.4056,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22327,null,"See CPT",2770.3962000000001,2770.3962000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22328,null,"See CPT",495.96820000000002,495.96820000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22505,null,"See CPT",235.7784,235.7784,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[22510,null,"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,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[22513,null,"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,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[22526,null,"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,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[22532,null,"See CPT",3219.9231999999997,3219.9231999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22533,null,"See CPT",2979.3815999999997,2979.3815999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22534,null,"See CPT",634.101,634.101,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22548,null,"See CPT",3512.2646,3512.2646,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22551,null,"See CPT",3043.0893999999998,3043.0893999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22552,null,"See CPT",696.02260000000001,696.02260000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22554,null,"See CPT",2270.2602000000002,2270.2602000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22556,null,"See CPT",2997.2436000000002,2997.2436000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22558,null,"See CPT",2735.2675999999997,2735.2675999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22585,null,"See CPT",572.17939999999999,572.17939999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22586,null,"See CPT",3630.7491999999997,3630.7491999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22590,null,"See CPT",2854.9430000000002,2854.9430000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22595,null,"See CPT",2725.7411999999999,2725.7411999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22600,null,"See CPT",2348.2575999999999,2348.2575999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22610,null,"See CPT",2312.5336000000002,2312.5336000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22612,null,"See CPT",2844.2258000000002,2844.2258000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22614,null,"See CPT",687.09159999999997,687.09159999999997,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22630,null,"See CPT",2792.4259999999999,2792.4259999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22632,null,"See CPT",562.65299999999991,562.65299999999991,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22633,null,"See CPT",3236.5944,3236.5944,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22634,null,"See CPT",850.82659999999998,850.82659999999998,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22800,null,"See CPT",2466.1468,2466.1468,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22802,null,"See CPT",3793.2934,3793.2934,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22804,null,"See CPT",4352.9694,4352.9694,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22808,null,"See CPT",3266.3643999999999,3266.3643999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22810,null,"See CPT",3612.2918,3612.2918,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22812,null,"See CPT",3960.0054000000005,3960.0054000000005,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22818,null,"See CPT",3859.3827999999994,3859.3827999999994,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22819,null,"See CPT",4445.2563999999993,4445.2563999999993,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22830,null,"See CPT",1488.5,1488.5,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22840,null,"See CPT",1332.5051999999998,1332.5051999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22841,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-UR",2,29]
[22842,null,"See CPT",1341.4362000000001,1341.4362000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22843,null,"See CPT",1436.1048000000001,1436.1048000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22844,null,"See CPT",1737.3771999999999,1737.3771999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22845,null,"See CPT",1276.5376000000001,1276.5376000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22846,null,"See CPT",1328.3373999999999,1328.3373999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22847,null,"See CPT",1419.4336000000001,1419.4336000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22848,null,"See CPT",633.50560000000007,633.50560000000007,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22849,null,"See CPT",2345.8759999999997,2345.8759999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22850,null,"See CPT",1333.6959999999999,1333.6959999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22852,null,"See CPT",1284.8731999999998,1284.8731999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22853,null,"See CPT",453.69479999999999,453.69479999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22854,null,"See CPT",588.85059999999999,588.85059999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22855,null,"See CPT",1996.3761999999999,1996.3761999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22856,null,"See CPT",2909.7197999999999,2909.7197999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22857,null,"See CPT",3184.1991999999996,3184.1991999999996,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22858,null,"See CPT",891.31380000000001,891.31380000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22859,null,"See CPT",585.27819999999997,585.27819999999997,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22860,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,2,2,0,null,"X",null,null,2,29]
[22861,null,"See CPT",4119.5725999999995,4119.5725999999995,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22862,null,"See CPT",4127.9081999999999,4127.9081999999999,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22864,null,"See CPT",3683.7397999999998,3683.7397999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22865,null,"See CPT",4030.8580000000002,4030.8580000000002,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22867,null,"See CPT",1937.4315999999999,1937.4315999999999,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22868,null,"See CPT",428.0926,428.0926,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22869,null,"See CPT",785.928,785.928,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22870,null,"See CPT",211.36699999999999,211.36699999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22899,null,"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,"See CPT",1024.6834000000001,1024.6834000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22901,null,"See CPT",1201.5172,1201.5172,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22902,null,"See CPT",877.61959999999999,609.0942,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22903,null,"See CPT",799.02679999999998,799.02679999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22904,null,"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,"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,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-UR",2,29]
[23000,null,"See CPT",1033.6143999999999,659.1078,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23020,null,"See CPT",1268.202,1268.202,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23030,null,"See CPT",827.01060000000007,465.6028,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[23031,null,"See CPT",820.46119999999996,409.03980000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23035,null,"See CPT",1253.317,1253.317,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23040,null,"See CPT",1318.2156,1318.2156,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23044,null,"See CPT",1046.7131999999999,1046.7131999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23065,null,"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,"See CPT",1062.789,676.96979999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23071,null,"See CPT",764.49360000000001,764.49360000000001,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[23073,null,"See CPT",1265.8204000000001,1265.8204000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23075,null,"See CPT",966.92959999999994,603.14020000000005,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23076,null,"See CPT",994.31799999999998,994.31799999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23077,null,"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,"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,"See CPT",940.13659999999993,940.13659999999993,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23101,null,"See CPT",847.84960000000001,847.84960000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23105,null,"See CPT",1177.1058,1177.1058,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23106,null,"See CPT",932.39639999999997,932.39639999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23107,null,"See CPT",1217.5929999999998,1217.5929999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23120,null,"See CPT",1086.605,1086.605,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23125,null,"See CPT",1304.5214000000001,1304.5214000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23130,null,"See CPT",1143.7634,1143.7634,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23140,null,"See CPT",1027.0650000000001,1027.0650000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23145,null,"See CPT",1279.5146,1279.5146,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23146,null,"See CPT",1150.9081999999999,1150.9081999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[23150,null,"See CPT",1228.3101999999999,1228.3101999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23155,null,"See CPT",1464.0886,1464.0886,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23156,null,"See CPT",1249.7446,1249.7446,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23170,null,"See CPT",1043.7362000000001,1043.7362000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23172,null,"See CPT",1055.0488,1055.0488,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23174,null,"See CPT",1405.7393999999999,1405.7393999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23180,null,"See CPT",1211.0436,1211.0436,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23182,null,"See CPT",1240.2181999999998,1240.2181999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23184,null,"See CPT",1361.6798000000001,1361.6798000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23190,null,"See CPT",1063.3843999999999,1063.3843999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23195,null,"See CPT",1362.2751999999998,1362.2751999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23200,null,"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,"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,"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,"See CPT",569.79780000000005,309.01260000000002,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[23333,null,"See CPT",875.23799999999994,875.23799999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[23334,null,"See CPT",1922.5465999999999,1922.5465999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23335,null,"See CPT",2295.2669999999998,2295.2669999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23350,null,"See CPT",312.58499999999998,89.31,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[23395,null,"See CPT",2329.2048,2329.2048,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23397,null,"See CPT",2068.4196000000002,2068.4196000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23400,null,"See CPT",1774.2919999999999,1774.2919999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23405,null,"See CPT",1133.0462,1133.0462,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23406,null,"See CPT",1367.6337999999998,1367.6337999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[23410,null,"See CPT",1501.5988,1501.5988,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23412,null,"See CPT",1558.1618000000001,1558.1618000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23415,null,"See CPT",1285.4685999999999,1285.4685999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23420,null,"See CPT",1780.2459999999999,1780.2459999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23430,null,"See CPT",1365.8476000000001,1365.8476000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23440,null,"See CPT",1384.3050000000001,1384.3050000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23450,null,"See CPT",1721.8968,1721.8968,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23455,null,"See CPT",1798.1079999999999,1798.1079999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23460,null,"See CPT",1982.6819999999998,1982.6819999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23462,null,"See CPT",1938.6224000000002,1938.6224000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23465,null,"See CPT",2032.6956,2032.6956,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23466,null,"See CPT",2044.6036000000001,2044.6036000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23470,null,"See CPT",2170.8283999999999,2170.8283999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23472,null,"See CPT",2612.6152000000002,2612.6152000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23473,null,"See CPT",2904.9566,2904.9566,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23474,null,"See CPT",3132.9947999999999,3132.9947999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23480,null,"See CPT",1499.8126,1499.8126,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[23485,null,"See CPT",1736.7818,1736.7818,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23490,null,"See CPT",1572.4513999999999,1572.4513999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23491,null,"See CPT",1850.5031999999999,1850.5031999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23500,null,"See CPT",426.90179999999998,436.4282,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23505,null,"See CPT",679.94679999999994,629.33780000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23515,null,"See CPT",1325.3604,1325.3604,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23520,null,"See CPT",459.64879999999999,454.29019999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23525,null,"See CPT",753.77639999999997,687.09159999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23530,null,"See CPT",1064.5752,1064.5752,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23532,null,"See CPT",1156.2668000000001,1156.2668000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23540,null,"See CPT",457.2672,451.90859999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23545,null,"See CPT",685.30539999999996,611.47579999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23550,null,"See CPT",1056.835,1056.835,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23552,null,"See CPT",1192.5862,1192.5862,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23570,null,"See CPT",447.1454,462.03039999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23575,null,"See CPT",777.5924,715.07539999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23585,null,"See CPT",1778.4598000000001,1778.4598000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23600,null,"See CPT",637.67340000000002,602.5447999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23605,null,"See CPT",887.7414,801.40840000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23615,null,"See CPT",1615.3201999999999,1615.3201999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23616,null,"See CPT",2241.0855999999999,2241.0855999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[23620,null,"See CPT",518.59340000000009,495.96820000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23625,null,"See CPT",735.31899999999996,669.82500000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23630,null,"See CPT",1433.1278,1433.1278,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23650,null,"See CPT",629.33780000000002,565.03459999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23655,null,"See CPT",763.30280000000005,763.30280000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23660,null,"See CPT",1083.6279999999999,1083.6279999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23665,null,"See CPT",820.46119999999996,750.20399999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23670,null,"See CPT",1592.0995999999998,1592.0995999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23675,null,"See CPT",1034.8052,932.39639999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23680,null,"See CPT",1696.8899999999999,1696.8899999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23700,null,"See CPT",360.81239999999997,360.81239999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23800,null,"See CPT",1870.1514,1870.1514,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23802,null,"See CPT",2330.991,2330.991,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23900,null,"See CPT",2506.0386000000003,2506.0386000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[23920,null,"See CPT",2040.4358000000002,2040.4358000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23921,null,"See CPT",874.04719999999998,874.04719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23929,null,"See CPT",0,0,"000",0,0,0,0,2,0,2,1,1,null,"B",null,"Y-UR",2,29]
[23930,null,"See CPT",675.779,392.964,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23931,null,"See CPT",575.7518,298.89079999999996,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23935,null,"See CPT",952.04459999999995,952.04459999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24000,null,"See CPT",886.55060000000003,886.55060000000003,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR",2,29]
[24006,null,"See CPT",1309.2846,1309.2846,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[24065,null,"See CPT",485.84640000000002,298.29539999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[24066,null,"See CPT",1168.7701999999999,775.80619999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24071,null,"See CPT",738.89139999999998,738.89139999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24073,null,"See CPT",1258.6756,1258.6756,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24075,null,"See CPT",1002.6536,607.30799999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24076,null,"See CPT",1003.8444,1003.8444,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24077,null,"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,"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,"See CPT",781.1647999999999,781.1647999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24101,null,"See CPT",936.56420000000003,936.56420000000003,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24102,null,"See CPT",1136.0231999999999,1136.0231999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24105,null,"See CPT",675.779,675.779,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24110,null,"See CPT",1091.9636,1091.9636,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24115,null,"See CPT",1353.3442,1353.3442,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24116,null,"See CPT",1570.6651999999999,1570.6651999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24120,null,"See CPT",986.57780000000002,986.57780000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24125,null,"See CPT",1149.1220000000001,1149.1220000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24126,null,"See CPT",1199.1356000000001,1199.1356000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24130,null,"See CPT",952.04459999999995,952.04459999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[24134,null,"See CPT",1371.8016,1371.8016,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24136,null,"See CPT",1165.7931999999998,1165.7931999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24138,null,"See CPT",1272.9651999999999,1272.9651999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24140,null,"See CPT",1293.8042,1293.8042,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24145,null,"See CPT",1097.3222000000001,1097.3222000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24147,null,"See CPT",1165.1977999999999,1165.1977999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24149,null,"See CPT",2158.9204,2158.9204,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24150,null,"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,"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,"See CPT",1556.3756000000001,1556.3756000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24160,null,"See CPT",2279.1912000000002,2279.1912000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24164,null,"See CPT",1328.9328,1328.9328,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24200,null,"See CPT",405.4674,256.61739999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[24201,null,"See CPT",1029.4466,676.96979999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24220,null,"See CPT",362.59859999999998,119.08,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[24300,null,"See CPT",824.03359999999998,824.03359999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24301,null,"See CPT",1380.7326,1380.7326,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24305,null,"See CPT",1070.5291999999999,1070.5291999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24310,null,"See CPT",881.19200000000001,881.19200000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24320,null,"See CPT",1429.5554,1429.5554,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24330,null,"See CPT",1319.4064000000001,1319.4064000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24331,null,"See CPT",1438.4864,1438.4864,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24332,null,"See CPT",1137.8093999999999,1137.8093999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[24340,null,"See CPT",1107.444,1107.444,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24341,null,"See CPT",1380.1371999999999,1380.1371999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24342,null,"See CPT",1418.8381999999999,1418.8381999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24343,null,"See CPT",1320.0018,1320.0018,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24344,null,"See CPT",1996.9715999999999,1996.9715999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24345,null,"See CPT",1311.6662000000001,1311.6662000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24346,null,"See CPT",2017.8106,2017.8106,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24357,null,"See CPT",778.18780000000004,778.18780000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24358,null,"See CPT",981.2192,981.2192,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24359,null,"See CPT",1221.1654000000001,1221.1654000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24360,null,"See CPT",1649.8534,1649.8534,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24361,null,"See CPT",1836.2136,1836.2136,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24362,null,"See CPT",1930.8822,1930.8822,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24363,null,"See CPT",2620.9508000000001,2620.9508000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24365,null,"See CPT",1179.4874,1179.4874,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24366,null,"See CPT",1251.5308,1251.5308,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24370,null,"See CPT",2781.1134000000002,2781.1134000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24371,null,"See CPT",3188.3669999999997,3188.3669999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24400,null,"See CPT",1517.0791999999999,1517.0791999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24410,null,"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,"See CPT",1957.6752000000001,1957.6752000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24430,null,"See CPT",1921.9512,1921.9512,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24435,null,"See CPT",1970.7740000000001,1970.7740000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24470,null,"See CPT",1237.8365999999999,1237.8365999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24495,null,"See CPT",1736.1864,1736.1864,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24498,null,"See CPT",1583.1686,1583.1686,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24500,null,"See CPT",690.66399999999999,635.29179999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24505,null,"See CPT",950.85379999999998,848.44499999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24515,null,"See CPT",1613.5340000000001,1613.5340000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24516,null,"See CPT",1569.4743999999998,1569.4743999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24530,null,"See CPT",730.55579999999998,666.84799999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24535,null,"See CPT",1163.4115999999999,1063.3843999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24538,null,"See CPT",1460.5162,1460.5162,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24545,null,"See CPT",1693.3176000000001,1693.3176000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24546,null,"See CPT",1888.6088,1888.6088,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24560,null,"See CPT",638.26880000000006,562.65299999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24565,null,"See CPT",1020.5156000000001,927.63319999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24566,null,"See CPT",1331.9098000000001,1331.9098000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24575,null,"See CPT",1347.9856,1347.9856,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24576,null,"See CPT",672.80200000000002,597.18619999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24577,null,"See CPT",1048.4993999999999,950.85379999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24579,null,"See CPT",1530.7734,1530.7734,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24582,null,"See CPT",1508.7436,1508.7436,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24586,null,"See CPT",1977.3234,1977.3234,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24587,null,"See CPT",1979.7049999999999,1979.7049999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24600,null,"See CPT",713.28920000000005,641.84119999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24605,null,"See CPT",893.1,893.1,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24615,null,"See CPT",1311.6662000000001,1311.6662000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24620,null,"See CPT",1092.559,1092.559,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24635,null,"See CPT",1247.9584,1247.9584,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24640,null,"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,"See CPT",506.68539999999996,469.7706,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24655,null,"See CPT",849.04039999999998,761.51659999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24665,null,"See CPT",1215.2113999999999,1215.2113999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24666,null,"See CPT",1347.3901999999998,1347.3901999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24670,null,"See CPT",559.67600000000004,510.25780000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24675,null,"See CPT",871.0702,784.73719999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24685,null,"See CPT",1207.4712,1207.4712,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24800,null,"See CPT",1527.7963999999999,1527.7963999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24802,null,"See CPT",1827.2826,1827.2826,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24900,null,"See CPT",1349.7718,1349.7718,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24920,null,"See CPT",1344.4132,1344.4132,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24925,null,"See CPT",1053.2626,1053.2626,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24930,null,"See CPT",1415.2657999999999,1415.2657999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24931,null,"See CPT",1695.1037999999999,1695.1037999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24935,null,"See CPT",2238.1086,2238.1086,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24940,null,"See CPT",2043.8668358222403,2043.8668358222403,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"F",null,"Y-UR",2,29]
[24999,null,"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,"See CPT",650.7722,650.7722,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25001,null,"See CPT",649.58140000000003,649.58140000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25020,null,"See CPT",1403.3578,1403.3578,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25023,null,"See CPT",2431.0182,2431.0182,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25024,null,"See CPT",1418.2428,1418.2428,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25025,null,"See CPT",2227.9868000000001,2227.9868000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25028,null,"See CPT",1308.6892,1308.6892,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25031,null,"See CPT",687.68700000000001,687.68700000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25035,null,"See CPT",1083.6279999999999,1083.6279999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25040,null,"See CPT",1031.8281999999999,1031.8281999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25065,null,"See CPT",481.08319999999998,290.55520000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[25066,null,"See CPT",684.71,684.71,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25071,null,"See CPT",774.61540000000002,774.61540000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25073,null,"See CPT",987.17319999999984,987.17319999999984,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25075,null,"See CPT",980.02840000000003,584.0874,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25076,null,"See CPT",959.78480000000002,959.78480000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25077,null,"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,"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,"See CPT",832.96460000000002,832.96460000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25100,null,"See CPT",654.34460000000001,654.34460000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25101,null,"See CPT",754.96719999999993,754.96719999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25105,null,"See CPT",907.38959999999997,907.38959999999997,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25107,null,"See CPT",1145.5495999999998,1145.5495999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25109,null,"See CPT",993.72260000000006,993.72260000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25110,null,"See CPT",648.98599999999999,648.98599999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25111,null,"See CPT",609.68960000000004,609.68960000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25112,null,"See CPT",728.17420000000004,728.17420000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25115,null,"See CPT",1394.4268000000002,1394.4268000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25116,null,"See CPT",1119.9474,1119.9474,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25118,null,"See CPT",715.07539999999995,715.07539999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25119,null,"See CPT",932.99180000000001,932.99180000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25120,null,"See CPT",932.39639999999997,932.39639999999997,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25125,null,"See CPT",1100.8945999999999,1100.8945999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25126,null,"See CPT",1108.6348,1108.6348,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25130,null,"See CPT",841.89560000000006,841.89560000000006,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25135,null,"See CPT",1037.7821999999999,1037.7821999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25136,null,"See CPT",924.6561999999999,924.6561999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25145,null,"See CPT",966.33420000000001,966.33420000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25150,null,"See CPT",1049.6902,1049.6902,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25151,null,"See CPT",1081.2464,1081.2464,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25170,null,"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,"See CPT",917.51139999999998,917.51139999999998,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25215,null,"See CPT",1145.5495999999998,1145.5495999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25230,null,"See CPT",806.1715999999999,806.1715999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25240,null,"See CPT",800.81299999999999,800.81299999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25246,null,"See CPT",373.31579999999997,129.7972,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[25248,null,"See CPT",769.85219999999993,769.85219999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25250,null,"See CPT",988.95939999999996,988.95939999999996,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25251,null,"See CPT",1321.788,1321.788,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25259,null,"See CPT",815.69799999999998,815.69799999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25260,null,"See CPT",1177.7012,1177.7012,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25263,null,"See CPT",1172.9379999999999,1172.9379999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25265,null,"See CPT",1381.328,1381.328,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25270,null,"See CPT",918.70219999999995,918.70219999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25272,null,"See CPT",1035.9959999999999,1035.9959999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25274,null,"See CPT",1228.9056,1228.9056,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25275,null,"See CPT",1240.2181999999998,1240.2181999999998,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25280,null,"See CPT",1047.904,1047.904,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25290,null,"See CPT",810.9348,810.9348,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25295,null,"See CPT",978.24220000000003,978.24220000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25300,null,"See CPT",1273.5606,1273.5606,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25301,null,"See CPT",1187.8229999999999,1187.8229999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25310,null,"See CPT",1149.7174,1149.7174,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25312,null,"See CPT",1320.5971999999999,1320.5971999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25315,null,"See CPT",1411.098,1411.098,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25316,null,"See CPT",1674.2647999999999,1674.2647999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25320,null,"See CPT",1820.7331999999999,1820.7331999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[25332,null,"See CPT",1550.4215999999999,1550.4215999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25335,null,"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,"See CPT",1635.5637999999999,1635.5637999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25350,null,"See CPT",1244.9813999999999,1244.9813999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25355,null,"See CPT",1402.7623999999998,1402.7623999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25360,null,"See CPT",1209.8527999999999,1209.8527999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25365,null,"See CPT",1676.0509999999999,1676.0509999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25370,null,"See CPT",1850.5031999999999,1850.5031999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25375,null,"See CPT",1740.9495999999999,1740.9495999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25390,null,"See CPT",1411.6934000000001,1411.6934000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25391,null,"See CPT",1815.3745999999999,1815.3745999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25392,null,"See CPT",1846.9307999999999,1846.9307999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25393,null,"See CPT",2051.1530000000002,2051.1530000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25394,null,"See CPT",1437.2955999999999,1437.2955999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25400,null,"See CPT",1471.8288,1471.8288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25405,null,"See CPT",1890.395,1890.395,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25415,null,"See CPT",1765.9564,1765.9564,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25420,null,"See CPT",2117.2424000000001,2117.2424000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25425,null,"See CPT",1758.2162000000001,1758.2162000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25426,null,"See CPT",2039.8403999999998,2039.8403999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25430,null,"See CPT",1346.7948000000001,1346.7948000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25431,null,"See CPT",1443.845,1443.845,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25440,null,"See CPT",1411.098,1411.098,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25441,null,"See CPT",1713.5612000000001,1713.5612000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25442,null,"See CPT",1486.7138,1486.7138,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25443,null,"See CPT",1442.6541999999999,1442.6541999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25444,null,"See CPT",1518.27,1518.27,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25445,null,"See CPT",1326.5512000000001,1326.5512000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25446,null,"See CPT",2132.7228,2132.7228,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25447,null,"See CPT",1531.3688,1531.3688,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25449,null,"See CPT",1885.0364,1885.0364,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25450,null,"See CPT",1140.7864,1140.7864,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25455,null,"See CPT",1345.0085999999999,1345.0085999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25490,null,"See CPT",1321.788,1321.788,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25491,null,"See CPT",1356.3212000000001,1356.3212000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25492,null,"See CPT",1657.5935999999999,1657.5935999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25500,null,"See CPT",544.79100000000005,491.20499999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25505,null,"See CPT",959.78480000000002,866.90240000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25515,null,"See CPT",1236.0504000000001,1236.0504000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25520,null,"See CPT",1084.2234000000001,1018.134,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25525,null,"See CPT",1455.7529999999999,1455.7529999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25526,null,"See CPT",1750.4759999999999,1750.4759999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25530,null,"See CPT",507.28079999999994,464.41199999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25535,null,"See CPT",935.96879999999999,859.16219999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25545,null,"See CPT",1157.4576,1157.4576,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25560,null,"See CPT",556.10360000000003,494.18200000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25565,null,"See CPT",981.81459999999993,872.85640000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25574,null,"See CPT",1247.9584,1247.9584,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25575,null,"See CPT",1658.7844,1658.7844,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25600,null,"See CPT",650.7722,621.00220000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25605,null,"See CPT",1016.3478,957.40319999999986,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25606,null,"See CPT",1239.0273999999999,1239.0273999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25607,null,"See CPT",1366.443,1366.443,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25608,null,"See CPT",1522.4377999999999,1522.4377999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25609,null,"See CPT",1928.5006000000001,1928.5006000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25622,null,"See CPT",589.44600000000003,543.00479999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25624,null,"See CPT",931.2056,840.10939999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25628,null,"See CPT",1325.3604,1325.3604,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25630,null,"See CPT",584.0874,541.81399999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25635,null,"See CPT",882.97820000000002,797.24059999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25645,null,"See CPT",1057.4304000000002,1057.4304000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25650,null,"See CPT",632.31479999999999,583.49200000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25651,null,"See CPT",913.93899999999996,913.93899999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25652,null,"See CPT",1152.6943999999999,1152.6943999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25660,null,"See CPT",843.68179999999995,843.68179999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25670,null,"See CPT",1124.1152,1124.1152,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25671,null,"See CPT",988.36400000000003,988.36400000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25675,null,"See CPT",863.92539999999997,774.61540000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25676,null,"See CPT",1165.1977999999999,1165.1977999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25680,null,"See CPT",991.34099999999989,991.34099999999989,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25685,null,"See CPT",1349.7718,1349.7718,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25690,null,"See CPT",919.89299999999992,919.89299999999992,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25695,null,"See CPT",1168.7701999999999,1168.7701999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25800,null,"See CPT",1346.7948000000001,1346.7948000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25805,null,"See CPT",1552.8031999999998,1552.8031999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25810,null,"See CPT",1590.9087999999999,1590.9087999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25820,null,"See CPT",1209.2574,1209.2574,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25825,null,"See CPT",1471.8288,1471.8288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25830,null,"See CPT",1890.395,1890.395,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25900,null,"See CPT",1317.0248000000001,1317.0248000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25905,null,"See CPT",1288.4456,1288.4456,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25907,null,"See CPT",1133.6415999999999,1133.6415999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25909,null,"See CPT",1260.4618,1260.4618,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25915,null,"See CPT",2114.2653999999998,2114.2653999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25920,null,"See CPT",1351.558,1351.558,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25922,null,"See CPT",1200.9218000000001,1200.9218000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25924,null,"See CPT",1320.0018,1320.0018,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25927,null,"See CPT",1614.7248,1614.7248,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25929,null,"See CPT",1105.6578,1105.6578,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25931,null,"See CPT",1498.0264,1498.0264,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25999,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[26010,null,"See CPT",658.51240000000007,261.976,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26011,null,"See CPT",920.48840000000007,343.54579999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26020,null,"See CPT",1032.4236000000001,1032.4236000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26025,null,"See CPT",779.97399999999993,779.97399999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26030,null,"See CPT",910.96199999999999,910.96199999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26034,null,"See CPT",1024.6834000000001,1024.6834000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26035,null,"See CPT",1581.3824,1581.3824,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26037,null,"See CPT",1035.4005999999999,1035.4005999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26040,null,"See CPT",594.20920000000001,594.20920000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26045,null,"See CPT",879.4058,879.4058,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26055,null,"See CPT",1128.8784000000001,546.57719999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26060,null,"See CPT",478.70159999999993,478.70159999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26070,null,"See CPT",603.73559999999998,603.73559999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26075,null,"See CPT",634.69640000000004,634.69640000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26080,null,"See CPT",746.03620000000001,746.03620000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26100,null,"See CPT",635.88720000000001,635.88720000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26105,null,"See CPT",640.65039999999999,640.65039999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26110,null,"See CPT",610.88040000000001,610.88040000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26111,null,"See CPT",767.47059999999999,767.47059999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26113,null,"See CPT",1010.3937999999999,1010.3937999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26115,null,"See CPT",1041.3545999999999,617.4298,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26116,null,"See CPT",972.8836,972.8836,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26117,null,"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,"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,"See CPT",1110.4209999999998,1110.4209999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26123,null,"See CPT",1546.2538,1546.2538,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26125,null,"See CPT",480.48779999999999,480.48779999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26130,null,"See CPT",874.04719999999998,874.04719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26135,null,"See CPT",1027.6604,1027.6604,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26140,null,"See CPT",943.70899999999995,943.70899999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26145,null,"See CPT",958.59400000000005,958.59400000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26160,null,"See CPT",1173.5334,591.23219999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26170,null,"See CPT",762.70740000000001,762.70740000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26180,null,"See CPT",839.51400000000001,839.51400000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26185,null,"See CPT",1036.5914,1036.5914,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26200,null,"See CPT",838.91859999999997,838.91859999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26205,null,"See CPT",1116.9704000000002,1116.9704000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26210,null,"See CPT",836.53700000000003,836.53700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26215,null,"See CPT",1050.8809999999999,1050.8809999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26230,null,"See CPT",927.63319999999999,927.63319999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26235,null,"See CPT",913.93899999999996,913.93899999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26236,null,"See CPT",819.86579999999992,819.86579999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26250,null,"See CPT",1938.6224000000002,1938.6224000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26260,null,"See CPT",1456.3484000000001,1456.3484000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26262,null,"See CPT",1160.4345999999998,1160.4345999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26320,null,"See CPT",653.15380000000005,653.15380000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26340,null,"See CPT",673.99279999999999,673.99279999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26341,null,"See CPT",221.4888,144.68219999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[26350,null,"See CPT",1415.8612000000001,1415.8612000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26352,null,"See CPT",1571.856,1571.856,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26356,null,"See CPT",1477.1873999999998,1477.1873999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26357,null,"See CPT",1647.4718,1647.4718,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26358,null,"See CPT",1811.2068000000002,1811.2068000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26370,null,"See CPT",1481.3552,1481.3552,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26372,null,"See CPT",1719.5151999999998,1719.5151999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26373,null,"See CPT",1658.1890000000001,1658.1890000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26390,null,"See CPT",1642.1131999999998,1642.1131999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26392,null,"See CPT",1873.1284000000001,1873.1284000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26410,null,"See CPT",1144.3588,1144.3588,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26412,null,"See CPT",1356.3212000000001,1356.3212000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26415,null,"See CPT",1599.2444,1599.2444,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26416,null,"See CPT",1725.4692,1725.4692,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26418,null,"See CPT",1191.3954000000001,1191.3954000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26420,null,"See CPT",1402.7623999999998,1402.7623999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26426,null,"See CPT",936.56420000000003,936.56420000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26428,null,"See CPT",1502.7895999999998,1502.7895999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26432,null,"See CPT",1037.7821999999999,1037.7821999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26433,null,"See CPT",1088.9866,1088.9866,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26434,null,"See CPT",1315.2385999999999,1315.2385999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26437,null,"See CPT",1262.8434,1262.8434,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26440,null,"See CPT",1238.432,1238.432,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26442,null,"See CPT",1860.625,1860.625,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26445,null,"See CPT",1158.0529999999999,1158.0529999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26449,null,"See CPT",1296.1858,1296.1858,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26450,null,"See CPT",884.16899999999998,884.16899999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26455,null,"See CPT",879.4058,879.4058,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26460,null,"See CPT",855.58979999999997,855.58979999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26471,null,"See CPT",1250.3399999999999,1250.3399999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26474,null,"See CPT",1236.6458,1236.6458,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26476,null,"See CPT",1221.1654000000001,1221.1654000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26477,null,"See CPT",1187.8229999999999,1187.8229999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26478,null,"See CPT",1256.2940000000001,1256.2940000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26479,null,"See CPT",1278.9192,1278.9192,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26480,null,"See CPT",1486.7138,1486.7138,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26483,null,"See CPT",1639.1362000000001,1639.1362000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26485,null,"See CPT",1576.6192000000001,1576.6192000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26489,null,"See CPT",1807.6343999999999,1807.6343999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26490,null,"See CPT",1573.6422,1573.6422,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26492,null,"See CPT",1735.5909999999999,1735.5909999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26494,null,"See CPT",1579.5962,1579.5962,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26496,null,"See CPT",1695.6992,1695.6992,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26497,null,"See CPT",1693.913,1693.913,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26498,null,"See CPT",2185.1179999999999,2185.1179999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26499,null,"See CPT",1633.7776000000001,1633.7776000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26500,null,"See CPT",1253.317,1253.317,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26502,null,"See CPT",1423.6014,1423.6014,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26508,null,"See CPT",1280.7054000000001,1280.7054000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26510,null,"See CPT",1217.5929999999998,1217.5929999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26516,null,"See CPT",1400.9762000000001,1400.9762000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26517,null,"See CPT",1624.2512000000002,1624.2512000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26518,null,"See CPT",1643.8994,1643.8994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26520,null,"See CPT",1297.972,1297.972,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26525,null,"See CPT",1302.7351999999998,1302.7351999999998,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26530,null,"See CPT",1001.4628,1001.4628,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26531,null,"See CPT",1169.3656000000001,1169.3656000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26535,null,"See CPT",816.29340000000002,816.29340000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26536,null,"See CPT",1418.8381999999999,1418.8381999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26540,null,"See CPT",1321.788,1321.788,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[26541,null,"See CPT",1563.5204000000001,1563.5204000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26542,null,"See CPT",1361.0844,1361.0844,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26545,null,"See CPT",1381.9234000000001,1381.9234000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26546,null,"See CPT",1943.981,1943.981,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26548,null,"See CPT",1503.9804000000001,1503.9804000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26550,null,"See CPT",3037.1353999999997,3037.1353999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26551,null,"See CPT",5971.8620000000001,5971.8620000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26553,null,"See CPT",5931.9701999999997,5931.9701999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26554,null,"See CPT",6894.732,6894.732,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26555,null,"See CPT",2563.7924000000003,2563.7924000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26556,null,"See CPT",6171.3209999999999,6171.3209999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26560,null,"See CPT",1205.0895999999998,1205.0895999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26561,null,"See CPT",1832.0457999999999,1832.0457999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26562,null,"See CPT",2544.7395999999999,2544.7395999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26565,null,"See CPT",1346.1994,1346.1994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26567,null,"See CPT",1356.9166,1356.9166,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26568,null,"See CPT",1747.499,1747.499,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26580,null,"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,"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,"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,"See CPT",931.2056,931.2056,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26593,null,"See CPT",1222.9515999999999,1222.9515999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26596,null,"See CPT",1526.0101999999999,1526.0101999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26600,null,"See CPT",577.5379999999999,548.9588,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26605,null,"See CPT",631.71939999999995,566.82079999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26607,null,"See CPT",954.42620000000011,954.42620000000011,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26608,null,"See CPT",900.84019999999998,900.84019999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26615,null,"See CPT",1068.7429999999999,1068.7429999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26641,null,"See CPT",796.04979999999989,721.02940000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26645,null,"See CPT",819.86579999999992,743.05920000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26650,null,"See CPT",904.4126,904.4126,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26665,null,"See CPT",1163.4115999999999,1163.4115999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[26670,null,"See CPT",660.89400000000001,587.06439999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26675,null,"See CPT",874.6425999999999,794.2636,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26676,null,"See CPT",956.21239999999989,956.21239999999989,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26685,null,"See CPT",1068.7429999999999,1068.7429999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26686,null,"See CPT",1149.7174,1149.7174,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26700,null,"See CPT",644.81820000000005,590.63679999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26705,null,"See CPT",830.58299999999997,747.82240000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26706,null,"See CPT",836.53700000000003,836.53700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26715,null,"See CPT",1065.1705999999999,1065.1705999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26720,null,"See CPT",385.81920000000002,361.40780000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26725,null,"See CPT",651.36759999999992,576.34719999999993,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26727,null,"See CPT",888.93219999999997,888.93219999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26735,null,"See CPT",1103.2762,1103.2762,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26740,null,"See CPT",446.55,422.73399999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26742,null,"See CPT",710.31219999999996,634.101,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26746,null,"See CPT",1368.8245999999999,1368.8245999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26750,null,"See CPT",359.6216,363.19399999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26755,null,"See CPT",610.28499999999997,519.78420000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26756,null,"See CPT",799.02679999999998,799.02679999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26765,null,"See CPT",938.94579999999996,938.94579999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26770,null,"See CPT",546.57719999999995,495.37279999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26775,null,"See CPT",753.18100000000004,672.20659999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26776,null,"See CPT",844.87259999999992,844.87259999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26785,null,"See CPT",1020.5156000000001,1020.5156000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26820,null,"See CPT",1557.5663999999999,1557.5663999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26841,null,"See CPT",1456.3484000000001,1456.3484000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[26842,null,"See CPT",1562.3295999999998,1562.3295999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26843,null,"See CPT",1470.6379999999999,1470.6379999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26844,null,"See CPT",1612.9386,1612.9386,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26850,null,"See CPT",1384.9004,1384.9004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26852,null,"See CPT",1564.7112,1564.7112,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26860,null,"See CPT",1164.6024,1164.6024,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26861,null,"See CPT",180.40619999999998,180.40619999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26862,null,"See CPT",1442.0588,1442.0588,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26863,null,"See CPT",406.65820000000002,406.65820000000002,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[26910,null,"See CPT",1433.1278,1433.1278,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26951,null,"See CPT",1325.9558,1325.9558,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26952,null,"See CPT",1291.4226000000001,1291.4226000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26989,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,1,1,1,null,"N",null,null,2,29]
[26990,null,"See CPT",1259.8663999999999,1259.8663999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26991,null,"See CPT",1325.3604,970.50200000000007,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26992,null,"See CPT",1845.1445999999999,1845.1445999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[27000,null,"See CPT",726.38799999999992,726.38799999999992,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27001,null,"See CPT",996.69959999999992,996.69959999999992,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27003,null,"See CPT",1105.6578,1105.6578,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27005,null,"See CPT",1311.0708,1311.0708,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27006,null,"See CPT",1307.4983999999999,1307.4983999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27025,null,"See CPT",1682.0049999999999,1682.0049999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27027,null,"See CPT",1623.6558,1623.6558,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27030,null,"See CPT",1704.0348000000001,1704.0348000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27033,null,"See CPT",1767.7426,1767.7426,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27035,null,"See CPT",2067.8241999999996,2067.8241999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27036,null,"See CPT",1854.0755999999999,1854.0755999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27040,null,"See CPT",636.48259999999993,362.59859999999998,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27041,null,"See CPT",1297.3765999999998,1297.3765999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27043,null,"See CPT",850.82659999999998,850.82659999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27045,null,"See CPT",1333.1006,1333.1006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27047,null,"See CPT",919.29759999999999,658.51240000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27048,null,"See CPT",1112.2072000000001,1112.2072000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27049,null,"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,"See CPT",754.37180000000001,754.37180000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27052,null,"See CPT",1068.7429999999999,1068.7429999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27054,null,"See CPT",1267.6065999999998,1267.6065999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27057,null,"See CPT",1830.855,1830.855,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27059,null,"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,"See CPT",862.7346,862.7346,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27062,null,"See CPT",841.89560000000006,841.89560000000006,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27065,null,"See CPT",976.4559999999999,976.4559999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27066,null,"See CPT",1503.385,1503.385,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27067,null,"See CPT",1887.4179999999999,1887.4179999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27070,null,"See CPT",1627.8235999999999,1627.8235999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27071,null,"See CPT",1793.9402,1793.9402,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27075,null,"See CPT",3740.8981999999996,3740.8981999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27076,null,"See CPT",4514.3227999999999,4514.3227999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27077,null,"See CPT",5028.1530000000002,5028.1530000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27078,null,"See CPT",3688.5030000000002,3688.5030000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27080,null,"See CPT",935.37340000000006,935.37340000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27086,null,"See CPT",589.44600000000003,311.39420000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27087,null,"See CPT",1119.9474,1119.9474,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27090,null,"See CPT",1520.0562,1520.0562,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27091,null,"See CPT",2873.4004,2873.4004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27093,null,"See CPT",445.95460000000003,122.05699999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27095,null,"See CPT",595.99540000000002,146.4684,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27096,null,"See CPT",304.24940000000004,148.85,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27097,null,"See CPT",1256.2940000000001,1256.2940000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27098,null,"See CPT",1278.9192,1278.9192,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27100,null,"See CPT",1521.8424,1521.8424,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27105,null,"See CPT",1592.6949999999999,1592.6949999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27110,null,"See CPT",1770.7195999999999,1770.7195999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27111,null,"See CPT",1650.4487999999999,1650.4487999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27120,null,"See CPT",2353.0208000000002,2353.0208000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27122,null,"See CPT",2002.9256,2002.9256,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27125,null,"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27130,null,"See CPT",2319.6784000000002,2319.6784000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27132,null,"See CPT",3011.5331999999999,3011.5331999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27134,null,"See CPT",3419.9775999999997,3419.9775999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27137,null,"See CPT",2639.4081999999999,2639.4081999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27138,null,"See CPT",2740.0308,2740.0308,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27140,null,"See CPT",1633.7776000000001,1633.7776000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27146,null,"See CPT",2297.0531999999998,2297.0531999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27147,null,"See CPT",2641.7898,2641.7898,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27151,null,"See CPT",2853.1568000000002,2853.1568000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27156,null,"See CPT",3071.0731999999998,3071.0731999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27158,null,"See CPT",2529.2592,2529.2592,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,null,2,29]
[27161,null,"See CPT",2212.5063999999998,2212.5063999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27165,null,"See CPT",2491.1536000000001,2491.1536000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27170,null,"See CPT",2120.8147999999997,2120.8147999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27175,null,"See CPT",1219.3792000000001,1219.3792000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[27176,null,"See CPT",1684.3865999999998,1684.3865999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27177,null,"See CPT",2028.5278000000001,2028.5278000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27178,null,"See CPT",1684.3865999999998,1684.3865999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27179,null,"See CPT",1783.8184000000001,1783.8184000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27181,null,"See CPT",2035.0771999999999,2035.0771999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27185,null,"See CPT",1319.4064000000001,1319.4064000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[27187,null,"See CPT",1814.7791999999999,1814.7791999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27197,null,"See CPT",247.09100000000001,247.09100000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[27198,null,"See CPT",572.77479999999991,572.77479999999991,"000",0,0,0,0,2,0,0,2,0,null,"R",null,null,2,29]
[27200,null,"See CPT",353.07219999999995,356.64460000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[27202,null,"See CPT",967.52499999999998,967.52499999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[27215,null,"See CPT",1097.9176,1097.9176,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27216,null,"See CPT",1622.4649999999999,1622.4649999999999,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27217,null,"See CPT",1526.0101999999999,1526.0101999999999,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27218,null,"See CPT",2088.6632,2088.6632,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27220,null,"See CPT",774.02,761.51659999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27222,null,"See CPT",1795.1309999999999,1795.1309999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27226,null,"See CPT",1915.9972,1915.9972,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27227,null,"See CPT",2974.0230000000001,2974.0230000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27228,null,"See CPT",3377.1088,3377.1088,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27230,null,"See CPT",907.98500000000001,889.52760000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27232,null,"See CPT",1313.4523999999999,1313.4523999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27235,null,"See CPT",1651.0442,1651.0442,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27236,null,"See CPT",2162.4928,2162.4928,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27238,null,"See CPT",869.28399999999999,869.28399999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27240,null,"See CPT",1742.1404,1742.1404,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27244,null,"See CPT",2223.819,2223.819,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27245,null,"See CPT",2222.0328,2222.0328,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27246,null,"See CPT",728.17420000000004,719.83859999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27248,null,"See CPT",1358.1073999999999,1358.1073999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27250,null,"See CPT",316.1574,316.1574,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27252,null,"See CPT",1372.9923999999999,1372.9923999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27253,null,"See CPT",1712.3704,1712.3704,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27254,null,"See CPT",2303.0072,2303.0072,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27256,null,"See CPT",576.34719999999993,431.06959999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27257,null,"See CPT",654.93999999999994,654.93999999999994,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27258,null,"See CPT",2019.5968,2019.5968,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27259,null,"See CPT",2787.6628000000001,2787.6628000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27265,null,"See CPT",774.61540000000002,774.61540000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27266,null,"See CPT",1077.0786000000001,1077.0786000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27267,null,"See CPT",819.2704,819.2704,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27268,null,"See CPT",1005.6306000000001,1005.6306000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27269,null,"See CPT",2241.681,2241.681,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27275,null,"See CPT",338.7826,338.7826,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[27279,null,"See CPT",1474.2104000000002,1474.2104000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27280,null,"See CPT",2444.7123999999999,2444.7123999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27282,null,"See CPT",1573.6422,1573.6422,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27284,null,"See CPT",2884.7130000000002,2884.7130000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27286,null,"See CPT",2962.1149999999998,2962.1149999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27290,null,"See CPT",2934.1311999999998,2934.1311999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27295,null,"See CPT",2268.4740000000002,2268.4740000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27299,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,"Y-UR",2,29]
[27301,null,"See CPT",1253.9123999999999,931.80100000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27303,null,"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27305,null,"See CPT",896.077,896.077,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27306,null,"See CPT",622.19299999999998,622.19299999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27307,null,"See CPT",756.1579999999999,756.1579999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27310,null,"See CPT",1345.0085999999999,1345.0085999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27323,null,"See CPT",513.83019999999999,321.51600000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27324,null,"See CPT",757.34879999999998,757.34879999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27325,null,"See CPT",1044.3316,1044.3316,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27326,null,"See CPT",968.71579999999994,968.71579999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27327,null,"See CPT",942.51819999999998,579.32420000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27328,null,"See CPT",1136.6186,1136.6186,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27329,null,"See CPT",1879.6777999999999,1879.6777999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27330,null,"See CPT",785.33259999999996,785.33259999999996,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27331,null,"See CPT",883.57359999999994,883.57359999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27332,null,"See CPT",1190.2045999999998,1190.2045999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27333,null,"See CPT",1089.5820000000001,1089.5820000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27334,null,"See CPT",1264.0342000000001,1264.0342000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27335,null,"See CPT",1403.3578,1403.3578,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27337,null,"See CPT",763.89819999999997,763.89819999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27339,null,"See CPT",1365.2521999999999,1365.2521999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27340,null,"See CPT",698.99959999999999,698.99959999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27345,null,"See CPT",900.24479999999994,900.24479999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27347,null,"See CPT",976.4559999999999,976.4559999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27350,null,"See CPT",1206.2804000000001,1206.2804000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27355,null,"See CPT",1121.7336,1121.7336,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27356,null,"See CPT",1358.7028,1358.7028,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27357,null,"See CPT",1501.5988,1501.5988,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27358,null,"See CPT",487.63259999999997,487.63259999999997,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27360,null,"See CPT",1665.3337999999999,1665.3337999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27364,null,"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,"See CPT",3686.7168000000001,3686.7168000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27369,null,"See CPT",355.4538,72.043399999999991,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27372,null,"See CPT",1103.2762,737.10520000000008,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27380,null,"See CPT",1158.6484,1158.6484,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27381,null,"See CPT",1511.1251999999999,1511.1251999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27385,null,"See CPT",1130.0691999999999,1130.0691999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27386,null,"See CPT",1576.6192000000001,1576.6192000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27390,null,"See CPT",835.94159999999999,835.94159999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27391,null,"See CPT",1071.72,1071.72,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[27392,null,"See CPT",1310.4754,1310.4754,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27393,null,"See CPT",928.22860000000003,928.22860000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27394,null,"See CPT",1203.3034,1203.3034,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27395,null,"See CPT",1613.5340000000001,1613.5340000000001,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27396,null,"See CPT",1140.7864,1140.7864,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27397,null,"See CPT",1672.4785999999999,1672.4785999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27400,null,"See CPT",1279.5146,1279.5146,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27403,null,"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27405,null,"See CPT",1243.1951999999999,1243.1951999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27407,null,"See CPT",1461.1116,1461.1116,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27409,null,"See CPT",1764.7655999999999,1764.7655999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27412,null,"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,"Y-UR",2,29]
[27415,null,"See CPT",2489.3674000000001,2489.3674000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27416,null,"See CPT",1783.8184000000001,1783.8184000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[27418,null,"See CPT",1518.27,1518.27,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27420,null,"See CPT",1368.8245999999999,1368.8245999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27422,null,"See CPT",1361.0844,1361.0844,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27424,null,"See CPT",1374.1831999999999,1374.1831999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27425,null,"See CPT",844.87259999999992,844.87259999999992,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27427,null,"See CPT",1303.9259999999999,1303.9259999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27428,null,"See CPT",2037.4587999999999,2037.4587999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27429,null,"See CPT",2295.8624,2295.8624,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27430,null,"See CPT",1361.6798000000001,1361.6798000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27435,null,"See CPT",1487.3091999999999,1487.3091999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27437,null,"See CPT",1215.8068000000001,1215.8068000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27438,null,"See CPT",1535.5365999999999,1535.5365999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27440,null,"See CPT",1460.5162,1460.5162,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27441,null,"See CPT",1506.9574,1506.9574,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27442,null,"See CPT",1590.9087999999999,1590.9087999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27443,null,"See CPT",1492.6677999999999,1492.6677999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27445,null,"See CPT",2271.451,2271.451,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27446,null,"See CPT",2077.9459999999999,2077.9459999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27447,null,"See CPT",2317.2968000000001,2317.2968000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27448,null,"See CPT",1513.5068000000001,1513.5068000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27450,null,"See CPT",1849.3123999999998,1849.3123999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27454,null,"See CPT",2343.4944,2343.4944,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27455,null,"See CPT",1756.43,1756.43,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27457,null,"See CPT",1746.9035999999999,1746.9035999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27465,null,"See CPT",2260.1383999999998,2260.1383999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27466,null,"See CPT",2150.5847999999996,2150.5847999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27468,null,"See CPT",2427.4458,2427.4458,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27470,null,"See CPT",2143.44,2143.44,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27472,null,"See CPT",2293.4808000000003,2293.4808000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27475,null,"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,"Y-UR",2,29]
[27477,null,"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,"Y-UR",2,29]
[27479,null,"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X",null,"Y-UR",2,29]
[27485,null,"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X",null,"Y-UR",2,29]
[27486,null,"See CPT",2537.5947999999999,2537.5947999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27487,null,"See CPT",3156.8108000000002,3156.8108000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27488,null,"See CPT",2177.3778000000002,2177.3778000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27495,null,"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27496,null,"See CPT",1015.7524,1015.7524,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27497,null,"See CPT",1068.1476,1068.1476,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R",null,null,2,29]
[27498,null,"See CPT",1210.4481999999998,1210.4481999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27499,null,"See CPT",1290.8271999999999,1290.8271999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27500,null,"See CPT",975.86059999999998,891.90920000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27501,null,"See CPT",938.35039999999992,921.67920000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27502,null,"See CPT",1376.5648000000001,1376.5648000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27503,null,"See CPT",1466.4702,1466.4702,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27506,null,"See CPT",2426.2550000000001,2426.2550000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27507,null,"See CPT",1754.0484000000001,1754.0484000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27508,null,"See CPT",981.2192,927.03779999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27509,null,"See CPT",1254.5078000000001,1254.5078000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27510,null,"See CPT",1247.9584,1247.9584,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27511,null,"See CPT",1802.8712,1802.8712,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27513,null,"See CPT",2227.9868000000001,2227.9868000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27514,null,"See CPT",1748.6898000000001,1748.6898000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27516,null,"See CPT",974.07439999999997,907.98500000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27517,null,"See CPT",1271.7744,1271.7744,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27519,null,"See CPT",1615.9156,1615.9156,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27520,null,"See CPT",621.59759999999994,572.77479999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27524,null,"See CPT",1381.328,1381.328,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27530,null,"See CPT",589.44600000000003,551.93579999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27532,null,"See CPT",1153.8851999999999,1071.1245999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27535,null,"See CPT",1626.0373999999999,1626.0373999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27536,null,"See CPT",2153.5617999999999,2153.5617999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27538,null,"See CPT",912.7482,845.46799999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27540,null,"See CPT",1491.4770000000001,1491.4770000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27550,null,"See CPT",965.14340000000004,881.78740000000005,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27552,null,"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27556,null,"See CPT",1590.3134,1590.3134,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27557,null,"See CPT",1888.6088,1888.6088,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27558,null,"See CPT",2145.2262000000001,2145.2262000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27560,null,"See CPT",709.12139999999999,645.41359999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27562,null,"See CPT",912.7482,912.7482,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27566,null,"See CPT",1627.8235999999999,1627.8235999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27570,null,"See CPT",284.00579999999997,284.00579999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27580,null,"See CPT",2680.4908,2680.4908,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27590,null,"See CPT",1389.0681999999999,1389.0681999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27591,null,"See CPT",1755.8345999999999,1755.8345999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27592,null,"See CPT",1194.3724,1194.3724,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27594,null,"See CPT",907.98500000000001,907.98500000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27596,null,"See CPT",1277.7284,1277.7284,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27598,null,"See CPT",1243.7906,1243.7906,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27599,null,"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,"See CPT",728.17420000000004,728.17420000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27601,null,"See CPT",807.95780000000002,807.95780000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27602,null,"See CPT",851.42200000000003,851.42200000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27603,null,"See CPT",985.38700000000006,718.05240000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27604,null,"See CPT",838.32320000000004,590.63679999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27605,null,"See CPT",616.83439999999996,334.6148,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27606,null,"See CPT",492.99119999999994,492.99119999999994,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,null,2,29]
[27607,null,"See CPT",1093.7498000000001,1093.7498000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27610,null,"See CPT",1182.4643999999998,1182.4643999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27612,null,"See CPT",1039.5684000000001,1039.5684000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27613,null,"See CPT",471.55680000000001,294.12760000000003,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27614,null,"See CPT",1097.9176,763.30280000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27615,null,"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,"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,"See CPT",915.12979999999993,562.65299999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27619,null,"See CPT",855.58979999999997,855.58979999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27620,null,"See CPT",818.07960000000003,818.07960000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27625,null,"See CPT",1047.904,1047.904,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27626,null,"See CPT",1116.375,1116.375,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27630,null,"See CPT",1000.8673999999999,653.74919999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27632,null,"See CPT",746.63159999999993,746.63159999999993,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27634,null,"See CPT",1229.501,1229.501,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27635,null,"See CPT",1064.5752,1064.5752,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27637,null,"See CPT",1356.9166,1356.9166,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27638,null,"See CPT",1365.8476000000001,1365.8476000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27640,null,"See CPT",1516.4838,1516.4838,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27641,null,"See CPT",1191.3954000000001,1191.3954000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27645,null,"See CPT",3182.413,3182.413,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27646,null,"See CPT",2770.3962000000001,2770.3962000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27647,null,"See CPT",1785.0092,1785.0092,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27648,null,"See CPT",409.6352,91.096199999999996,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[27650,null,"See CPT",1209.2574,1209.2574,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27652,null,"See CPT",1208.662,1208.662,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27654,null,"See CPT",1308.6892,1308.6892,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27656,null,"See CPT",1007.4168000000001,638.86419999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27658,null,"See CPT",680.54219999999998,680.54219999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27659,null,"See CPT",862.13919999999996,862.13919999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27664,null,"See CPT",671.61119999999994,671.61119999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[27665,null,"See CPT",776.40159999999992,776.40159999999992,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27675,null,"See CPT",912.7482,912.7482,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27676,null,"See CPT",1111.0164,1111.0164,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27680,null,"See CPT",769.2568,769.2568,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[27681,null,"See CPT",928.22860000000003,928.22860000000003,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27685,null,"See CPT",1222.9515999999999,855.58979999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27686,null,"See CPT",965.73879999999997,965.73879999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27687,null,"See CPT",834.15539999999999,834.15539999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27690,null,"See CPT",1170.5563999999999,1170.5563999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27691,null,"See CPT",1362.2751999999998,1362.2751999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27692,null,"See CPT",178.02460000000002,178.02460000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[27695,null,"See CPT",891.31380000000001,891.31380000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27696,null,"See CPT",1003.249,1003.249,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27698,null,"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27700,null,"See CPT",1116.375,1116.375,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27702,null,"See CPT",1747.499,1747.499,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27703,null,"See CPT",2016.6197999999997,2016.6197999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27704,null,"See CPT",1043.1407999999999,1043.1407999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27705,null,"See CPT",1377.7556,1377.7556,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27707,null,"See CPT",753.18100000000004,753.18100000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27709,null,"See CPT",2055.9162000000001,2055.9162000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27712,null,"See CPT",2003.521,2003.521,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27715,null,"See CPT",1949.3396,1949.3396,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27720,null,"See CPT",1595.0765999999999,1595.0765999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27722,null,"See CPT",1635.5637999999999,1635.5637999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27724,null,"See CPT",2266.0924,2266.0924,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27725,null,"See CPT",2209.5293999999999,2209.5293999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27726,null,"See CPT",1740.3542,1740.3542,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27727,null,"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,"See CPT",1084.8188,1084.8188,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[27732,null,"See CPT",843.68179999999995,843.68179999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27734,null,"See CPT",1210.4481999999998,1210.4481999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27740,null,"See CPT",1300.3535999999999,1300.3535999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27742,null,"See CPT",1424.7921999999999,1424.7921999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27745,null,"See CPT",1382.5187999999998,1382.5187999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27750,null,"See CPT",661.48939999999993,612.07119999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27766,null,"See CPT",1119.9474,1119.9474,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27786,null,"See CPT",598.37700000000007,545.38639999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27826,null,"See CPT",1574.2376000000002,1574.2376000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27840,null,"See CPT",723.41100000000006,723.41100000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27888,null,"See CPT",1155.6713999999999,1155.6713999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27893,null,"See CPT",1132.4508000000001,1132.4508000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28008,null,"See CPT",793.66819999999996,538.83699999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28047,null,"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]
[28070,null,"See CPT",938.94579999999996,627.55159999999989,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28107,null,"See CPT",932.39639999999997,630.52859999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[28124,null,"See CPT",880.00119999999993,610.28499999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28171,null,"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]
[28225,null,"See CPT",768.06600000000003,484.06020000000007,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28232,null,"See CPT",700.78579999999999,440.596,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28262,null,"See CPT",2563.7924000000003,2041.6265999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28296,null,"See CPT",1646.8763999999999,933.58719999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28305,null,"See CPT",1220.57,1220.57,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28341,null,"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]
[28445,null,"See CPT",1890.9904000000001,1890.9904000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28475,null,"See CPT",484.65560000000005,423.9248,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28540,null,"See CPT",366.17099999999999,328.06540000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28585,null,"See CPT",1630.2051999999999,1272.9651999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28606,null,"See CPT",711.50299999999993,711.50299999999993,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28725,null,"See CPT",1420.6243999999999,1420.6243999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28760,null,"See CPT",1400.3807999999999,1029.4466,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29040,null,"See CPT",551.93579999999997,314.37119999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29126,null,"See CPT",145.27760000000001,89.9054,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29305,null,"See CPT",464.41199999999998,288.17359999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29505,null,"See CPT",166.11660000000001,94.668599999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29581,null,"See CPT",169.09359999999998,48.227400000000003,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29705,null,"See CPT",115.5076,80.379000000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29819,null,"See CPT",1079.4602,1079.4602,"090",0.1,0.69,0.21,0,3,1,1,1,0,29805,"R",null,"Y-UR",2,29]
[29826,null,"See CPT",306.03559999999999,306.03559999999999,"000",0,0,0,0,0,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29845,null,"See CPT",1081.8418000000001,1081.8418000000001,"090",0.1,0.69,0.21,0,3,1,2,1,0,29840,"R",null,"Y-UR",2,29]
[29866,null,"See CPT",1919.5696,1919.5696,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[29875,null,"See CPT",915.12979999999993,915.12979999999993,"090",0.1,0.69,0.21,0,3,1,0,0,0,29870,"R",null,"Y-UR",2,29]
[29888,null,"See CPT",1774.2919999999999,1774.2919999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29897,null,"See CPT",912.15279999999996,912.15279999999996,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[29900,null,"See CPT",936.56420000000003,936.56420000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[30020,null,"See CPT",517.40260000000001,226.84739999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[30124,null,"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"X",null,null,2,29]
[30400,null,"See CPT",2316.7013999999999,2316.7013999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R",null,null,2,29]
[30462,null,"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,2,2,0,null,"X",null,null,2,29]
[30801,null,"See CPT",418.56619999999998,289.36439999999999,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R",null,null,2,29]
[31020,null,"See CPT",828.79679999999996,669.2296,"090",0.1,0.76,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[31075,null,"See CPT",1550.4215999999999,1550.4215999999999,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,29]
[31084,null,"See CPT",2254.1844000000001,2254.1844000000001,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,29]
[31235,null,"See CPT",585.27819999999997,287.57819999999998,"000",0,0,0,0,3,1,0,0,0,31231,"R",null,null,2,29]
[31254,null,"See CPT",821.65200000000004,437.02359999999999,"000",0,0,0,0,3,1,1,0,0,31231,"R",null,null,2,29]
[31293,null,"See CPT",1955.8890000000001,1955.8890000000001,"010",0.1,0.8,0.1,0,3,1,0,0,0,31231,"R",null,null,2,29]
[31300,null,"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]
[31420,null,"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]
[31520,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[31541,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,31526,"X",null,null,2,29]
[31551,null,"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,0,1,0,null,"X",null,null,2,29]
[31580,null,"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,0,1,0,null,"X",null,null,2,29]
[31590,null,"See CPT",1743.3312000000001,1743.3312000000001,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31614,null,"See CPT",1325.9558,1325.9558,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[31627,null,"See CPT",2079.1368000000002,168.4982,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[31640,null,"See CPT",437.61899999999997,437.61899999999997,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,"Y-CM",2,29]
[31660,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,31622,"X",null,null,2,29]
[31755,null,"See CPT",3240.1668,3240.1668,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31770,null,"See CPT",2318.4875999999999,2318.4875999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32098,null,"See CPT",1335.4821999999999,1335.4821999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32120,null,"See CPT",1538.5136,1538.5136,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32320,null,"See CPT",2820.4097999999999,2820.4097999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32482,null,"See CPT",2766.8238000000001,2766.8238000000001,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32550,null,"See CPT",1499.8126,360.21699999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[32604,null,"See CPT",830.58299999999997,830.58299999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[32652,null,"See CPT",2904.3611999999998,2904.3611999999998,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[32655,null,"See CPT",1680.8142,1680.8142,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[32673,null,"See CPT",2124.3872000000001,2124.3872000000001,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32800,null,"See CPT",1670.097,1670.097,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32905,null,"See CPT",2332.7772,2332.7772,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32999,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,1,1,1,null,"N",null,"Y-CM",2,29]
[33140,null,"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33210,null,"See CPT",281.02879999999999,281.02879999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33223,null,"See CPT",729.96039999999994,729.96039999999994,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[33226,null,"See CPT",855.58979999999997,855.58979999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33249,null,"See CPT",1617.7018,1617.7018,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[33254,null,"See CPT",2373.8597999999997,2373.8597999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33267,null,"See CPT",1821.924,1821.924,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33274,null,"See CPT",849.63580000000002,849.63580000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,2,0,null,"R",null,"Y-UR",2,29]
[33335,null,"See CPT",3246.1208000000001,3246.1208000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33366,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,2,1,null,"X",null,null,2,29]
[33412,null,"See CPT",5438.3836000000001,5438.3836000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33415,null,"See CPT",3517.6232,3517.6232,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33468,null,"See CPT",4245.7974000000004,4245.7974000000004,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33475,null,"See CPT",4034.4304000000002,4034.4304000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33507,null,"See CPT",2986.5263999999997,2986.5263999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[33514,null,"See CPT",4520.2767999999996,4520.2767999999996,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33536,null,"See CPT",4566.7179999999998,4566.7179999999998,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33606,null,"See CPT",3100.2478000000001,3100.2478000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33645,null,"See CPT",3007.9608000000003,3007.9608000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33665,null,"See CPT",3318.1641999999997,3318.1641999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33726,null,"See CPT",3522.9818,3522.9818,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33735,null,"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33775,null,"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33778,null,"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]
[33814,null,"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]
[33852,null,"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33883,null,"See CPT",1917.1880000000001,1917.1880000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,null,2,29]
[33889,null,"See CPT",1356.9166,1356.9166,"000",0,0,0,0,2,1,2,2,0,null,"R",null,null,2,29]
[33924,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,2,1,0,null,"X",null,null,2,29]
[33927,null,"See CPT",4384.5255999999999,4384.5255999999999,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[33952,null,"See CPT",738.89139999999998,738.89139999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[33958,null,"See CPT",317.34820000000002,317.34820000000002,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[33973,null,"See CPT",862.7346,862.7346,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33980,null,"See CPT",3071.0731999999998,3071.0731999999998,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33992,null,"See CPT",323.30219999999997,323.30219999999997,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[34101,null,"See CPT",1034.2098000000001,1034.2098000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[34510,null,"See CPT",1753.453,1753.453,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[34701,null,"See CPT",2127.9596000000001,2127.9596000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[34717,null,"See CPT",754.96719999999993,754.96719999999993,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[34812,null,"See CPT",351.286,351.286,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-CM",2,29]
[34844,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,2,2,0,null,"N",null,null,2,29]
[35005,null,"See CPT",1711.7749999999999,1711.7749999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35111,null,"See CPT",2275.0234,2275.0234,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35142,null,"See CPT",2272.0463999999997,2272.0463999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35211,null,"See CPT",2421.4918000000002,2421.4918000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35226,null,"See CPT",1441.4634000000001,1441.4634000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35304,null,"See CPT",2182.7363999999998,2182.7363999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35311,null,"See CPT",2698.3528000000001,2698.3528000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35500,null,"See CPT",541.21860000000004,541.21860000000004,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35512,null,"See CPT",2061.2747999999997,2061.2747999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35536,null,"See CPT",2889.4762000000001,2889.4762000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35560,null,"See CPT",2913.2921999999999,2913.2921999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35606,null,"See CPT",2017.8106,2017.8106,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35621,null,"See CPT",1885.6318000000001,1885.6318000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35656,null,"See CPT",1848.1215999999999,1848.1215999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35665,null,"See CPT",2018.4059999999999,2018.4059999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35686,null,"See CPT",272.69319999999999,272.69319999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35840,null,"See CPT",2142.8445999999999,2142.8445999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35907,null,"See CPT",3256.8380000000002,3256.8380000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[36013,null,"See CPT",1504.5757999999998,218.51179999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36222,null,"See CPT",2305.3887999999997,493.58659999999992,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[36225,null,"See CPT",2941.2759999999998,562.65299999999991,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[36400,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[36410,null,"See CPT",32.151600000000002,16.075800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36450,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[36476,null,"See CPT",526.33359999999993,231.61060000000001,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM",2,29]
[36516,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[36561,null,"See CPT",1864.7927999999999,590.63679999999999,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[36578,null,"See CPT",812.12560000000008,362.59859999999998,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[36589,null,"See CPT",301.86779999999999,244.70940000000002,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[36640,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[36800,null,"See CPT",213.1532,213.1532,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36823,null,"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]
[36901,null,"See CPT",1340.2454,292.34140000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[37180,null,"See CPT",3755.7831999999999,3755.7831999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[37187,null,"See CPT",3241.953,682.32839999999999,"000",0,0,0,0,2,1,1,2,0,null,"R",null,null,2,29]
[37215,null,"See CPT",1716.5382,1716.5382,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37223,null,"See CPT",2431.6136000000001,362.00319999999999,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37235,null,"See CPT",7617.5475999999999,643.03200000000004,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37238,null,"See CPT",6634.5421999999999,528.11979999999994,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[37247,null,"See CPT",1062.789,295.91379999999998,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR",2,29]
[37609,null,"See CPT",579.32420000000002,368.55260000000004,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[37650,null,"See CPT",796.04979999999989,796.04979999999989,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[37799,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[38208,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[38215,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[38308,null,"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]
[38382,null,"See CPT",1216.9976000000001,1216.9976000000001,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[38531,null,"See CPT",807.36239999999998,807.36239999999998,"090",0.11,0.73,0.16,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[38720,null,"See CPT",2423.8733999999999,2423.8733999999999,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[38765,null,"See CPT",2344.0897999999997,2344.0897999999997,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[39401,null,"See CPT",538.24159999999995,538.24159999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[40500,null,"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]
[40652,null,"See CPT",975.26519999999994,666.25259999999992,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[40806,null,"See CPT",189.93260000000001,53.585999999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[40812,null,"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]
[40831,null,"See CPT",557.88979999999992,371.52960000000002,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41009,null,"See CPT",794.85899999999992,523.952,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41100,null,"See CPT",354.26300000000003,197.6728,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[41140,null,"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]
[41599,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[41823,null,"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]
[42100,null,"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]
[42107,null,"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]
[42200,null,"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X",null,null,2,29]
[42299,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,null,2,29]
[42340,null,"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,1,0,0,0,null,"X",null,null,2,29]
[42500,null,"See CPT",845.46799999999996,641.24579999999992,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42720,null,"See CPT",824.03359999999998,701.38119999999992,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42810,null,"See CPT",734.72360000000003,525.73820000000001,"090",0.09,0.81,0.1,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[42845,null,"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]
[42950,null,"See CPT",1491.4770000000001,1491.4770000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[42960,null,"See CPT",294.72300000000001,294.72300000000001,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[43101,null,"See CPT",1773.1012000000001,1773.1012000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43118,null,"See CPT",6288.6148000000003,6288.6148000000003,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[43195,null,"See CPT",334.01940000000002,334.01940000000002,"000",0,0,0,0,3,0,1,0,0,43191,"R",null,null,2,29]
[43212,null,"See CPT",334.6148,334.6148,"000",0,0,0,0,3,0,1,0,0,43200,"R",null,null,2,29]
[43226,null,"See CPT",732.93740000000003,231.61060000000001,"000",0,0,0,0,3,0,1,0,0,43200,"R",null,null,2,29]
[43241,null,"See CPT",251.85420000000002,251.85420000000002,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43248,null,"See CPT",781.1647999999999,295.3184,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43251,null,"See CPT",937.15959999999995,348.30899999999997,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43265,null,"See CPT",766.27979999999991,766.27979999999991,"000",0,0,0,0,3,0,1,0,0,43260,"R",null,"Y-CM",2,29]
[43277,null,"See CPT",669.82500000000005,669.82500000000005,"000",0,0,0,0,3,0,1,0,0,43260,"R",null,null,2,29]
[43289,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[43313,null,"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]
[43336,null,"See CPT",2531.0454,2531.0454,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43415,null,"See CPT",4517.2997999999998,4517.2997999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43497,null,"See CPT",1424.1968000000002,1424.1968000000002,"090",0.09,0.81,0.1,0,3,0,1,0,0,43235,"R",null,"Y-CM",2,29]
[43501,null,"See CPT",2396.4850000000001,2396.4850000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43633,null,"See CPT",3408.0696000000003,3408.0696000000003,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43647,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[43761,null,"See CPT",224.4658,184.57400000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[43774,null,"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]
[43845,null,"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]
[43888,null,"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]
[44005,null,"See CPT",1941.0040000000001,1941.0040000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44110,null,"See CPT",1517.0791999999999,1517.0791999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44136,null,"See CPT","By Report ","By Report ","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,29]
[44145,null,"See CPT",2929.3679999999999,2929.3679999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44187,null,"See CPT",1960.0568000000001,1960.0568000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44207,null,"See CPT",3210.9922000000001,3210.9922000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44316,null,"See CPT",2517.3512000000001,2517.3512000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44369,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,0,0,0,44360,"X",null,null,2,29]
[44379,null,"See CPT",725.19719999999995,725.19719999999995,"000",0,0,0,0,3,0,0,0,0,44376,"R",null,"Y-CM",2,29]
[44382,null,"See CPT",571.58399999999995,132.77420000000001,"000",0,0,0,0,3,0,1,0,0,44380,"R",null,"Y-CM",2,29]
[44407,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,44388,"X",null,null,2,29]
[44602,null,"See CPT",2490.5581999999999,2490.5581999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44680,null,"See CPT",1917.1880000000001,1917.1880000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44799,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,1,1,1,null,"N",null,null,2,29]
[45005,null,"See CPT",598.37700000000007,304.84480000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[45121,null,"See CPT",3106.2018000000003,3106.2018000000003,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45160,null,"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]
[45190,null,"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]
[45334,null,"See CPT",943.11360000000002,210.17619999999999,"000",0,0,0,0,3,0,1,0,0,45330,"R",null,"Y-CM",2,29]
[45338,null,"See CPT",565.03459999999995,214.34399999999999,"000",0,0,0,0,3,0,1,0,0,45330,"R",null,"Y-CM",2,29]
[45381,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,45378,"X",null,null,2,29]
[45390,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,45378,"X",null,null,2,29]
[45505,null,"See CPT",1101.49,1101.49,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45900,null,"See CPT",384.6284,384.6284,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[46030,null,"See CPT",485.84640000000002,155.9948,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[46050,null,"See CPT",449.52699999999999,185.76480000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46270,null,"See CPT",999.08120000000008,737.70060000000001,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46285,null,"See CPT",1049.0948000000001,776.40159999999992,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46611,null,"See CPT",425.11559999999997,144.68219999999999,"000",0,0,0,0,3,0,1,0,0,46600,"R",null,"Y-CM",2,29]
[46707,null,"See CPT",921.0838,921.0838,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[46750,null,"See CPT",1355.7257999999999,1355.7257999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46910,null,"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]
[46999,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[47010,null,"See CPT",2169.6376,2169.6376,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[47147,null,"See CPT",668.63419999999996,668.63419999999996,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47360,null,"See CPT",3330.6675999999998,3330.6675999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[47420,null,"See CPT",2375.6459999999997,2375.6459999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47533,null,"See CPT",2233.3453999999997,463.81659999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[47550,null,"See CPT",287.57819999999998,287.57819999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[47563,null,"See CPT",1289.0409999999999,1289.0409999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[47712,null,"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]
[47721,null,"See CPT",2419.1102000000001,2419.1102000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48102,null,"See CPT",968.71579999999994,417.9708,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[48140,null,"See CPT",2785.8766000000001,2785.8766000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48547,null,"See CPT",3180.0313999999998,3180.0313999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[48551,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,2,1,0,null,"N",null,"Y-CM",2,29]
[49060,null,"See CPT",1951.7212,1951.7212,"090",0.09,0.81,0.1,0,2,0,1,1,0,null,"R",null,null,2,29]
[49203,null,"See CPT",2133.3181999999997,2133.3181999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[49326,null,"See CPT",328.66079999999999,328.66079999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[49400,null,"See CPT",277.45640000000003,159.56720000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[49428,null,"See CPT",771.63840000000005,771.63840000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[49436,null,"See CPT",1030.6373999999998,334.6148,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[49505,null,"See CPT",942.51819999999998,942.51819999999998,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49553,null,"See CPT",1138.4048,1138.4048,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49600,null,"See CPT",1320.0018,1320.0018,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[49615,null,"See CPT",1131.26,1131.26,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[49905,null,"See CPT",619.81140000000005,619.81140000000005,"000",0,0,0,0,0,0,2,2,0,null,"R",null,null,2,29]
[50010,null,"See CPT",1335.4821999999999,1335.4821999999999,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50205,null,"See CPT",1348.5809999999999,1348.5809999999999,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50230,null,"See CPT",2270.2602000000002,2270.2602000000002,"090",0.08,0.83,0.09,0,2,1,2,2,0,null,"R",null,null,2,29]
[50365,null,"See CPT",5175.8122000000003,5175.8122000000003,"090",0.08,0.83,0.09,0,2,1,2,2,2,null,"R",null,"Y-CM",2,29]
[50382,null,"See CPT",1923.1419999999998,442.38219999999995,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[50431,null,"See CPT",619.81140000000005,117.8892,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[50500,null,"See CPT",2227.9868000000001,2227.9868000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[50548,null,"See CPT",2377.4321999999997,2377.4321999999997,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50562,null,"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]
[50606,null,"See CPT",917.51139999999998,241.73239999999998,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM",2,29]
[50630,null,"See CPT",1589.7179999999998,1589.7179999999998,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50727,null,"See CPT",920.48840000000007,920.48840000000007,"090",0.08,0.83,0.09,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[50750,null,"See CPT",2048.7713999999996,2048.7713999999996,"090",0.08,0.83,0.09,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[50830,null,"See CPT",3191.9393999999998,3191.9393999999998,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[50940,null,"See CPT",1585.5501999999999,1585.5501999999999,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50974,null,"See CPT",829.98759999999993,829.98759999999993,"000",0,0,0,0,3,1,0,0,0,50970,"R",null,"Y-CM",2,29]
[51050,null,"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]
[51550,null,"See CPT",1715.3473999999999,1715.3473999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[51570,null,"See CPT",2613.2105999999999,2613.2105999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[51710,null,"See CPT",253.04499999999999,142.89599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[51725,null,"See CPT",431.06959999999998,431.06959999999998,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51727,"TC","See CPT",504.30380000000002,504.30380000000002,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51741,26,"See CPT",14.885,14.885,"000",0,0,0,1,2,0,1,0,0,null,"R",null,null,2,29]
[51797,"TC","See CPT",295.91379999999998,295.91379999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,29]
[51845,null,"See CPT",1045.5223999999998,1045.5223999999998,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[51999,null,"See CPT","By Report ","By Report ","000",0,0,0,0,0,0,0,1,1,null,"N",null,null,2,29]
[52005,null,"See CPT",570.39319999999998,234.58759999999998,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52281,null,"See CPT",612.07119999999998,269.12079999999997,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52285,null,"See CPT",652.55840000000001,345.33199999999999,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52315,null,"See CPT",870.47479999999996,484.06020000000007,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52344,null,"See CPT",648.39060000000006,648.39060000000006,"000",0,0,0,0,3,1,1,0,0,52000,"R",null,null,2,29]
[52442,null,"See CPT",1670.6923999999999,88.714600000000004,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[52648,null,"See CPT",3032.3721999999998,1239.6228000000001,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[53210,null,"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]
[53230,null,"See CPT",1094.3452,1094.3452,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53440,null,"See CPT",1346.7948000000001,1346.7948000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53445,null,"See CPT",1357.5119999999999,1357.5119999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53452,null,"See CPT","By Report ","By Report ","010",0.1,0.8,0.1,0,0,0,0,0,0,null,"N",null,null,2,29]
[53605,null,"See CPT",113.12599999999999,113.12599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[54000,null,"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,0,0,0,null,"X",null,null,2,29]
[54060,null,"See CPT",362.00319999999999,238.16,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[54150,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[54205,null,"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,0,2,0,0,null,"X",null,null,2,29]
[54304,null,"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,0,2,0,0,null,"X",null,null,2,29]
[54316,null,"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]
[54336,null,"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]
[54406,null,"See CPT",1309.8799999999999,1309.8799999999999,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[54440,null,"See CPT","By Report ","By Report ","090",0.1,0.8,0.1,0,2,0,2,1,0,null,"N",null,null,2,29]
[54550,null,"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]
[54699,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[54865,null,"See CPT",651.96299999999997,651.96299999999997,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[55180,null,"See CPT",1237.8365999999999,1237.8365999999999,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[55300,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,2,0,0,0,null,"X",null,null,2,29]
[55550,null,"See CPT",774.61540000000002,774.61540000000002,"090",0.1,0.8,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[55810,null,"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]
[55867,null,"See CPT",1866.579,1866.579,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[55899,null,"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[56606,null,"See CPT",70.852599999999995,52.395200000000003,"000",0,0,0,0,0,0,1,2,0,null,"R",null,"Y-CM",2,29]
[56634,null,"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"X",null,null,2,29]
[57020,null,"See CPT",233.9922,141.70519999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[57061,null,"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]
[57110,null,"See CPT",1636.7546,1636.7546,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57210,null,"See CPT",721.02940000000001,721.02940000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[57267,null,"See CPT",445.95460000000003,445.95460000000003,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57292,null,"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]
[57400,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[57426,null,"See CPT",1582.5731999999998,1582.5731999999998,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57513,null,"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]
[57530,null,"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]
[57558,null,"See CPT",295.3184,237.56460000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[58180,null,"See CPT",1732.0185999999999,1732.0185999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58267,null,"See CPT",1937.4315999999999,1937.4315999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58322,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[58541,null,"See CPT",1325.9558,1325.9558,"090",0.12,0.74,0.14000000000000001,0,3,0,2,2,0,49320,"R",null,"Y-CM",2,29]
[58550,null,"See CPT",1595.672,1595.672,"090",0.12,0.74,0.14000000000000001,0,3,0,2,2,0,49320,"R",null,"Y-CM",2,29]
[58570,null,"See CPT",1464.0886,1464.0886,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[58600,null,"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]
[58615,null,"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,2,0,0,null,"X",null,null,2,29]
[58740,null,"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]
[58820,null,"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,1,2,0,0,null,"X",null,null,2,29]
[58954,null,"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]
[59015,null,"See CPT",283.41039999999998,231.01519999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59030,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[59140,null,"See CPT",755.56259999999997,755.56259999999997,"090",0.17,0.6,0.23,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[59325,null,"See CPT",424.52019999999999,424.52019999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59409,null,"See CPT",1415.2657999999999,1415.2657999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59612,null,"See CPT",1594.4811999999999,1594.4811999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59821,null,"See CPT",796.04979999999989,686.49619999999993,"090",0.17,0.6,0.23,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59871,null,"See CPT",235.7784,235.7784,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[60252,null,"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]
[60300,null,"See CPT",201.24519999999998,86.332999999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[60650,null,"See CPT",2116.0515999999998,2116.0515999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[61050,null,"See CPT",144.08679999999998,144.08679999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[61105,null,"See CPT",846.0634,846.0634,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R",null,null,2,29]
[61253,null,"See CPT",1785.0092,1785.0092,"090",0.11,0.76,0.13,0,2,2,2,0,0,null,"R",null,null,2,29]
[61316,null,"See CPT",153.01779999999999,153.01779999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[61460,null,"See CPT",3751.02,3751.02,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,null,2,29]
[61517,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[61535,null,"See CPT",1814.1838,1814.1838,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61550,null,"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]
[61564,null,"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,1,2,1,0,null,"X",null,null,2,29]
[61571,null,"See CPT",3549.7747999999997,3549.7747999999997,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61592,null,"See CPT",5679.5205999999998,5679.5205999999998,"090",0.11,0.76,0.13,0,2,1,2,1,2,null,"R",null,"Y-CM",2,29]
[61605,null,"See CPT",3968.9363999999996,3968.9363999999996,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM",2,29]
[61626,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[61650,null,"See CPT",1003.8444,1003.8444,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[61703,null,"See CPT",2436.9722000000002,2436.9722000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61770,null,"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,0,1,1,0,null,"X",null,null,2,29]
[61797,null,"See CPT",382.24680000000001,382.24680000000001,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[61800,null,"See CPT",265.54840000000002,265.54840000000002,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[62117,null,"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]
[62140,null,"See CPT",1838.5952,1838.5952,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[62165,null,"See CPT",2729.3136,2729.3136,"090",0.11,0.76,0.13,0,2,0,0,1,0,null,"R",null,"Y-CM",2,29]
[62220,null,"See CPT",1734.9956,1734.9956,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[62268,null,"See CPT",457.86260000000004,457.86260000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[62292,null,"See CPT",1047.3086000000001,1047.3086000000001,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[62321,null,"See CPT",492.99119999999994,191.1234,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62324,null,"See CPT",254.83120000000002,158.9718,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62370,null,"See CPT",172.666,82.165199999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[63003,null,"See CPT",2211.3155999999999,2211.3155999999999,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63043,null,"See CPT",1308.4410810556803,1308.4410810556803,"000",0,0,0,0,0,1,2,2,0,null,"F",null,"Y-UR",2,29]
[63051,null,"See CPT",3035.3491999999997,3035.3491999999997,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63081,null,"See CPT",3145.4982,3145.4982,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-UR",2,29]
[63172,null,"See CPT",2528.6637999999998,2528.6637999999998,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63250,null,"See CPT",5251.4279999999999,5251.4279999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63265,null,"See CPT",2988.9079999999999,2988.9079999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63285,null,"See CPT",4645.3107999999993,4645.3107999999993,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63290,null,"See CPT",4950.1556,4950.1556,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63610,null,"See CPT",1021.1109999999999,1021.1109999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[63663,null,"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,"Y-UR",2,29]
[63741,null,"See CPT",1244.386,1244.386,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[64416,null,"See CPT",138.13279999999997,138.13279999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64449,null,"See CPT",110.7444,110.7444,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64454,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[64493,null,"See CPT",329.25620000000004,162.54419999999999,"000",0,0,0,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[64505,null,"See CPT",264.35760000000005,188.1464,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64575,null,"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,0,1,0,0,null,"X",null,"Y-CM",2,29]
[64590,null,"See CPT",489.41880000000003,291.74600000000004,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[64625,null,"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]
[64635,null,"See CPT",830.58299999999997,345.33199999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[64681,null,"See CPT",863.33,401.89499999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64708,null,"See CPT",924.06079999999997,924.06079999999997,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[64742,null,"See CPT",904.4126,904.4126,"090",0.11,0.76,0.13,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[64755,null,"See CPT",1645.0901999999999,1645.0901999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[64786,null,"See CPT",1796.9171999999999,1796.9171999999999,"090",0.11,0.76,0.13,0,2,1,2,0,0,null,"R",null,null,2,29]
[64804,null,"See CPT",2145.2262000000001,2145.2262000000001,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[64837,null,"See CPT",643.62739999999997,643.62739999999997,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[64862,null,"See CPT",2475.0778,2475.0778,"090",0.11,0.76,0.13,0,2,1,2,0,0,null,"R",null,null,2,29]
[64892,null,"See CPT",1900.5168000000001,1900.5168000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64896,null,"See CPT",2572.1280000000002,2572.1280000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[65105,null,"See CPT",1777.269,1777.269,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[65114,null,"See CPT",2904.3611999999998,2904.3611999999998,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[65272,null,"See CPT",984.7915999999999,643.03200000000004,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65280,null,"See CPT",1218.7837999999999,1218.7837999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[65710,null,"See CPT",2084.4953999999998,2084.4953999999998,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[65765,null,"See CPT",4748.8941686609287,4748.8941686609287,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,29]
[65800,null,"See CPT",219.10720000000001,159.56720000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[65820,null,"See CPT",1520.6515999999999,1520.6515999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[66160,null,"See CPT",1799.2987999999998,1799.2987999999998,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66174,null,"See CPT",1139.0001999999999,1139.0001999999999,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[66680,null,"See CPT",953.23540000000003,953.23540000000003,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66710,null,"See CPT",812.721,711.50299999999993,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[66850,null,"See CPT",1431.9370000000001,1431.9370000000001,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[66984,null,"See CPT",988.36400000000003,988.36400000000003,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67025,null,"See CPT",1367.6337999999998,1149.1220000000001,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[67040,null,"See CPT",1874.9145999999998,1874.9145999999998,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67121,null,"See CPT",1637.9454000000001,1637.9454000000001,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67208,null,"See CPT",1099.7038,1047.3086000000001,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67318,null,"See CPT",1245.5768,1245.5768,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[67332,null,"See CPT",376.88819999999998,376.88819999999998,"000",0,0,0,0,0,1,1,1,0,null,"R",null,"Y-CM",2,29]
[67414,null,"See CPT",2676.9184,2676.9184,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67500,null,"See CPT",139.3236,114.3168,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[67805,null,"See CPT",375.10199999999998,297.7,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[67840,null,"See CPT",528.11979999999994,286.38739999999996,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[67909,null,"See CPT",1020.5156000000001,798.43140000000005,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67914,null,"See CPT",915.72520000000009,600.7586,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67974,null,"See CPT",1668.9062000000001,1668.9062000000001,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[68020,null,"See CPT",223.87039999999999,201.24519999999998,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[68330,null,"See CPT",1159.2438,837.7278,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[68400,null,"See CPT",562.05759999999998,238.75539999999998,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[68705,null,"See CPT",491.80039999999997,301.86779999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[68801,null,"See CPT",179.8108,145.87300000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[69090,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[69110,null,"See CPT",890.12299999999993,611.47579999999994,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[69420,null,"See CPT",362.59859999999998,223.87039999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69433,null,"See CPT",382.24680000000001,245.3048,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69511,null,"See CPT",2354.8069999999998,2354.8069999999998,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[69620,null,"See CPT",1405.144,919.29759999999999,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[69646,null,"See CPT",2927.5817999999999,2927.5817999999999,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[69670,null,"See CPT",1756.43,1756.43,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[69725,null,"See CPT",3430.6947999999998,3430.6947999999998,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R",null,null,2,29]
[69728,null,"See CPT","Not Covered","Not Covered","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"X",null,null,2,29]
[69960,null,"See CPT",3443.1981999999998,3443.1981999999998,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,26]
[69990,null,"See CPT",379.26979999999998,379.26979999999998,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,26]
[70030,26,"See CPT",16.075800000000001,16.075800000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70130,26,"See CPT",29.77,29.77,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70160,26,"See CPT",15.480399999999999,15.480399999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70200,null,"See CPT",91.096199999999996,91.096199999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70250,null,"See CPT",68.470999999999989,68.470999999999989,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70260,null,"See CPT",84.54679999999999,84.54679999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70330,"TC","See CPT",79.783600000000007,79.783600000000007,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[70332,"TC","See CPT",113.72139999999999,113.72139999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70350,"TC","See CPT",15.480399999999999,15.480399999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70371,26,"See CPT",74.424999999999997,74.424999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70460,26,"See CPT",97.05019999999999,97.05019999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70481,null,"See CPT",354.85840000000002,354.85840000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70487,26,"See CPT",97.05019999999999,97.05019999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70491,26,"See CPT",119.08,119.08,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70540,26,"See CPT",115.5076,115.5076,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70542,26,"See CPT",139.3236,139.3236,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70545,null,"See CPT",449.52699999999999,449.52699999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70549,null,"See CPT",682.92380000000003,682.92380000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70554,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,4,3,0,0,0,null,"X",null,null,2,26]
[70557,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[71046,"TC","See CPT",44.655000000000001,44.655000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71048,26,"See CPT",26.792999999999999,26.792999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71111,26,"See CPT",27.983799999999999,27.983799999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[71120,26,"See CPT",17.266599999999997,17.266599999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71260,null,"See CPT",326.87459999999999,326.87459999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[71550,null,"See CPT",674.58820000000003,674.58820000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[71552,"TC","See CPT",746.63159999999993,746.63159999999993,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72050,"TC","See CPT",77.402000000000001,77.402000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72074,"TC","See CPT",62.517000000000003,62.517000000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72081,26,"See CPT",22.6252,22.6252,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72100,26,"See CPT",19.648199999999999,19.648199999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72110,26,"See CPT",22.6252,22.6252,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72125,null,"See CPT",253.04499999999999,253.04499999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72129,null,"See CPT",332.82859999999999,332.82859999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72131,"TC","See CPT",166.71199999999999,166.71199999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72142,"TC","See CPT",389.39159999999998,389.39159999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72149,"TC","See CPT",380.4606,380.4606,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72157,26,"See CPT",197.07740000000001,197.07740000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72190,26,"See CPT",22.029799999999998,22.029799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72191,26,"See CPT",153.61320000000001,153.61320000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72194,null,"See CPT",502.51759999999996,502.51759999999996,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72198,null,"See CPT",668.63419999999996,668.63419999999996,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72202,"TC","See CPT",54.776800000000001,54.776800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72265,"TC","See CPT",135.1558,135.1558,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73000,"TC","See CPT",46.441200000000002,46.441200000000002,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73020,26,"See CPT",13.098800000000001,13.098800000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73060,26,"See CPT",14.885,14.885,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73085,null,"See CPT",212.55779999999999,212.55779999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73090,null,"See CPT",55.372199999999999,55.372199999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73115,null,"See CPT",258.99899999999997,258.99899999999997,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73130,"TC","See CPT",54.776800000000001,54.776800000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73202,"TC","See CPT",389.39159999999998,389.39159999999998,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73220,"TC","See CPT",631.71939999999995,631.71939999999995,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73222,26,"See CPT",139.91900000000001,139.91900000000001,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73502,26,"See CPT",19.648199999999999,19.648199999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73522,null,"See CPT",101.8134,101.8134,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73523,null,"See CPT",117.8892,117.8892,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73560,null,"See CPT",64.898600000000002,64.898600000000002,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73564,"TC","See CPT",68.470999999999989,68.470999999999989,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73592,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[73610,26,"See CPT",15.480399999999999,15.480399999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73650,26,"See CPT",13.6942,13.6942,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73702,26,"See CPT",104.19499999999999,104.19499999999999,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73719,null,"See CPT",519.18880000000001,519.18880000000001,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73720,null,"See CPT",668.03880000000004,668.03880000000004,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73723,"TC","See CPT",582.89659999999992,582.89659999999992,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[74019,26,"See CPT",20.243600000000001,20.243600000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74160,26,"See CPT",109.5536,109.5536,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74175,null,"See CPT",604.33100000000002,604.33100000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74181,null,"See CPT",384.6284,384.6284,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74190,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74220,"TC","See CPT",136.3466,136.3466,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74221,"TC","See CPT",151.827,151.827,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74246,"TC","See CPT",190.52800000000002,190.52800000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74250,26,"See CPT",69.066399999999987,69.066399999999987,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74263,26,"See CPT",195.88659999999999,195.88659999999999,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM",2,26]
[74283,null,"See CPT",484.06020000000007,484.06020000000007,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74328,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74355,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74363,"TC","See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74400,"TC","See CPT",217.91640000000001,217.91640000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74430,26,"See CPT",27.388400000000001,27.388400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74440,26,"See CPT",31.5562,31.5562,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74470,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[74712,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,4,0,0,0,0,null,"X",null,null,2,26]
[74775,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[75563,null,"See CPT",835.34619999999995,835.34619999999995,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75571,"TC","See CPT",144.68219999999999,144.68219999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75572,"TC","See CPT",293.53219999999999,293.53219999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75635,null,"See CPT",804.98079999999993,804.98079999999993,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[75705,null,"See CPT",460.83960000000002,460.83960000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75731,null,"See CPT",288.17359999999996,288.17359999999996,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75736,"TC","See CPT",174.4522,174.4522,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75756,"TC","See CPT",205.41300000000001,205.41300000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75805,"TC","See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75809,26,"See CPT",41.677999999999997,41.677999999999997,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75810,26,"See CPT",85.7376,85.7376,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75833,null,"See CPT",273.28859999999997,273.28859999999997,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75840,null,"See CPT",243.51859999999999,243.51859999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75872,null,"See CPT",243.51859999999999,243.51859999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75885,"TC","See CPT",138.72820000000002,138.72820000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75893,"TC","See CPT",151.827,151.827,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75898,26,"See CPT",158.9718,158.9718,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75957,26,"See CPT",494.7774,494.7774,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75958,26,"See CPT",328.06540000000001,328.06540000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76010,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76080,null,"See CPT",112.53059999999999,112.53059999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76125,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[76376,26,"See CPT",17.266599999999997,17.266599999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76391,26,"See CPT",94.668599999999998,94.668599999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[76498,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR",2,26]
[76511,null,"See CPT",106.5766,106.5766,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76512,null,"See CPT",89.31,89.31,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76529,"TC","See CPT",103.5996,103.5996,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[76536,"TC","See CPT",163.1396,163.1396,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76705,26,"See CPT",51.2044,51.2044,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76706,26,"See CPT",47.0366,47.0366,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76776,"TC","See CPT",217.321,217.321,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76805,"TC","See CPT",170.87980000000002,170.87980000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76813,"TC","See CPT",117.8892,117.8892,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76814,26,"See CPT",85.142199999999988,85.142199999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76819,26,"See CPT",66.089400000000012,66.089400000000012,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76820,"TC","See CPT",41.082599999999999,41.082599999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76830,null,"See CPT",228.03819999999999,228.03819999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76831,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,4,0,0,0,0,null,"X",null,null,2,26]
[76872,null,"See CPT",383.43760000000003,383.43760000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76881,"TC","See CPT",20.84,20.84,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,26]
[76932,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[76936,null,"See CPT",485.84640000000002,485.84640000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76945,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76946,26,"See CPT",32.747,32.747,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76978,26,"See CPT",139.3236,139.3236,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76979,26,"See CPT",73.234200000000001,73.234200000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76998,26,"See CPT",107.76739999999999,107.76739999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77002,null,"See CPT",221.4888,221.4888,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77013,null,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[77021,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,9,0,0,null,"X",null,null,2,26]
[77048,"TC","See CPT",485.25100000000003,485.25100000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[77049,"TC","See CPT",481.08319999999998,481.08319999999998,"000",0,0,0,1,4,2,0,0,0,null,"R",null,"Y-UR",2,26]
[77063,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,2,9,0,0,null,"X",null,null,2,26]
[77065,26,"See CPT",69.066399999999987,69.066399999999987,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77073,"TC","See CPT",61.3262,61.3262,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77075,26,"See CPT",47.632000000000005,47.632000000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77080,26,"See CPT",17.266599999999997,17.266599999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77085,null,"See CPT",98.241,98.241,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77263,null,"See CPT",305.4402,305.4402,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77280,26,"See CPT",69.066399999999987,69.066399999999987,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77300,null,"See CPT",123.24779999999998,123.24779999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77301,null,"See CPT",3484.2808,3484.2808,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77317,null,"See CPT",606.71259999999995,606.71259999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77321,26,"See CPT",91.096199999999996,91.096199999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77334,"TC","See CPT",124.43859999999999,124.43859999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77371,null,"See CPT","By Report ","By Report ","000",0,0,0,3,0,0,0,0,0,null,"N",null,null,2,26]
[77412,null,"See CPT","By Report ","By Report ","000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77424,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[77525,null,"See CPT","By Report ","By Report ","000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77600,26,"See CPT",129.20179999999999,129.20179999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77615,null,"See CPT",2064.2518,2064.2518,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77762,null,"See CPT",1024.6834000000001,1024.6834000000001,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77770,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77772,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77799,26,"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78012,"TC","See CPT",138.13279999999997,138.13279999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78018,26,"See CPT",70.257199999999997,70.257199999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78020,26,"See CPT",47.632000000000005,47.632000000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78072,null,"See CPT",774.61540000000002,774.61540000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78103,null,"See CPT",331.04239999999999,331.04239999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78120,null,"See CPT",133.36960000000002,133.36960000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78122,"TC","See CPT",150.04079999999999,150.04079999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78191,"TC","See CPT",189.3372,189.3372,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78195,26,"See CPT",100.02719999999999,100.02719999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78226,null,"See CPT",577.5379999999999,577.5379999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78227,null,"See CPT",776.99700000000007,776.99700000000007,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78231,"TC","See CPT",158.37640000000002,158.37640000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78262,"TC","See CPT",379.86520000000002,379.86520000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78268,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[78290,null,"See CPT",587.06439999999998,587.06439999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78305,null,"See CPT",490.01420000000002,490.01420000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78315,"TC","See CPT",528.11979999999994,528.11979999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78428,null,"See CPT",333.42399999999998,333.42399999999998,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78429,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR",2,26]
[78431,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR",2,26]
[78445,"TC","See CPT",331.04239999999999,331.04239999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78454,"TC","See CPT",658.51240000000007,658.51240000000007,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78457,26,"See CPT",63.112400000000001,63.112400000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78468,26,"See CPT",66.68480000000001,66.68480000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78473,null,"See CPT",511.4486,511.4486,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78492,null,"See CPT",3319.8478978167363,3319.8478978167359,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR",2,26]
[78494,null,"See CPT",405.4674,405.4674,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78499,26,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78597,"TC","See CPT",295.91379999999998,295.91379999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78599,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78606,26,"See CPT",54.181400000000004,54.181400000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78630,26,"See CPT",57.753799999999998,57.753799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78650,null,"See CPT",482.27399999999994,482.27399999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78701,null,"See CPT",402.49039999999997,402.49039999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78707,null,"See CPT",414.39839999999998,414.39839999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78709,"TC","See CPT",538.24159999999995,538.24159999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78761,"TC","See CPT",319.13440000000003,319.13440000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78800,26,"See CPT",54.776800000000001,54.776800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78804,26,"See CPT",83.951399999999992,83.951399999999992,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78814,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78816,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78835,26,"See CPT",38.105600000000003,38.105600000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79101,null,"See CPT",272.09780000000001,272.09780000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79200,"TC","See CPT",101.21799999999999,101.21799999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[79445,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,23]
[80048,null,"See CPT",12.013200000000001,12.013200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80150,null,"See CPT",21.413599999999999,21.413599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80167,null,"See CPT",26.468799999999998,26.468799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80176,null,"See CPT",20.8598,20.8598,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80189,null,"See CPT",38.496199999999995,38.496199999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80198,null,"See CPT",20.078800000000001,20.078800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80201,null,"See CPT",16.926399999999997,16.926399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80306,null,"See CPT",24.338799999999999,24.338799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80325,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80337,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80349,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80356,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80368,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80375,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80400,null,"See CPT",46.320399999999992,46.320399999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80422,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80505,null,"See CPT",173.85679999999999,162.54419999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,23]
[81007,null,"See CPT",42.571599999999997,42.571599999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81106,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81164,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81177,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81184,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81187,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81204,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81212,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81226,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81233,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81245,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81257,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81264,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81267,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81279,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81289,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81301,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81308,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81320,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81332,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81339,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81342,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81362,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81370,null,"See CPT",571.0104,571.0104,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81382,null,"See CPT",175.62559999999999,175.62559999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81405,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81418,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81435,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81442,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81448,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81506,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81509,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81525,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81540,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82010,null,"See CPT",11.6014,11.6014,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82042,null,"See CPT",11.047599999999999,11.047599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82107,null,"See CPT",91.462199999999996,91.462199999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82127,null,"See CPT",20.1356,20.1356,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82180,null,"See CPT",14.043800000000001,14.043800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82239,null,"See CPT",24.310400000000001,24.310400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82306,null,"See CPT",42.031999999999996,42.031999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82360,null,"See CPT",18.275399999999998,18.275399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82384,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82438,null,"See CPT",7.1,7.1,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82533,null,"See CPT",23.146000000000001,23.146000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82550,null,"See CPT",9.2441999999999993,9.2441999999999993,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82633,null,"See CPT",43.991599999999998,43.991599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82642,null,"See CPT",41.577599999999997,41.577599999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82679,null,"See CPT",35.428999999999995,35.428999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82725,null,"See CPT",26.653399999999998,26.653399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82777,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82941,null,"See CPT",25.034599999999998,25.034599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82955,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82963,null,"See CPT",30.5016,30.5016,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83018,null,"See CPT",31.183199999999999,31.183199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83021,null,"See CPT",25.645199999999996,25.645199999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83090,null,"See CPT",25.446400000000001,25.446400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[83497,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83529,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83605,null,"See CPT",16.429400000000001,16.429400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83670,null,"See CPT",13.930199999999999,13.930199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83698,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83861,null,"See CPT",31.921599999999998,31.921599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83873,null,"See CPT",24.423999999999999,24.423999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83951,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83987,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84100,null,"See CPT",6.7308000000000003,6.7308000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84126,null,"See CPT",55.536199999999994,55.536199999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84152,null,"See CPT",26.113800000000001,26.113800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84163,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84207,null,"See CPT",39.902000000000001,39.902000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84228,null,"See CPT",16.514600000000002,16.514600000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84307,null,"See CPT",25.957599999999999,25.957599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84375,null,"See CPT",55.379999999999995,55.379999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84432,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84445,null,"See CPT",72.221199999999996,72.221199999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84485,null,"See CPT",10.224,10.224,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84540,null,"See CPT",7.8951999999999991,7.8951999999999991,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84591,null,"See CPT",24.225199999999997,24.225199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84620,null,"See CPT",18.3322,18.3322,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85025,null,"See CPT",11.033399999999999,11.033399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85041,null,"See CPT",4.2884000000000002,4.2884000000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85210,null,"See CPT",18.4316,18.4316,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85247,null,"See CPT",32.574800000000003,32.574800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85303,null,"See CPT",19.652799999999999,19.652799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85347,null,"See CPT",6.0776000000000003,6.0776000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85390,null,"See CPT",21.9816,21.9816,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85400,null,"See CPT",10.9482,10.9482,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85549,null,"See CPT",26.625,26.625,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[85576,null,"See CPT",35.372199999999999,35.372199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85613,null,"See CPT",13.6036,13.6036,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86000,null,"See CPT",9.9116,9.9116,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86039,null,"See CPT",15.847199999999999,15.847199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86078,null,"See CPT",96.454800000000006,88.119199999999992,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,23]
[86160,null,"See CPT",17.04,17.04,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86171,null,"See CPT",14.214199999999998,14.214199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86301,null,"See CPT",29.550199999999997,29.550199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86308,null,"See CPT",7.355599999999999,7.355599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86320,26,"See CPT",31.5562,31.5562,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[86335,26,"See CPT",31.5562,31.5562,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[86359,null,"See CPT",53.576599999999992,53.576599999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86376,null,"See CPT",20.661000000000001,20.661000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86480,null,"See CPT",88.011599999999987,88.011599999999987,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86486,null,"See CPT",11.908000000000001,11.908000000000001,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,23]
[86606,null,"See CPT",21.370999999999999,21.370999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86628,null,"See CPT",17.054199999999998,17.054199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86645,null,"See CPT",23.927,23.927,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86671,null,"See CPT",17.395,17.395,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86698,null,"See CPT",19.581799999999998,19.581799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86707,null,"See CPT",16.429400000000001,16.429400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86738,null,"See CPT",18.800799999999999,18.800799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86757,null,"See CPT",27.477,27.477,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86787,null,"See CPT",18.2896,18.2896,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86790,null,"See CPT",18.2896,18.2896,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86806,null,"See CPT",67.577799999999996,67.577799999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86830,null,"See CPT",135.63839999999999,135.63839999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86886,null,"See CPT",7.355599999999999,7.355599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86905,null,"See CPT",5.4386000000000001,5.4386000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86940,null,"See CPT",12.453399999999998,12.453399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86971,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[87046,null,"See CPT",13.404799999999998,13.404799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87073,null,"See CPT",13.7172,13.7172,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87088,null,"See CPT",11.4878,11.4878,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87147,null,"See CPT",7.355599999999999,7.355599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87164,26,"See CPT",34.533199999999994,34.533199999999994,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[87187,null,"See CPT",57.041400000000003,57.041400000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87250,null,"See CPT",27.775199999999998,27.775199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87267,null,"See CPT",19.0564,19.0564,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87281,null,"See CPT",17.011600000000001,17.011600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87290,null,"See CPT",19.0564,19.0564,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87327,null,"See CPT",19.0564,19.0564,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87380,null,"See CPT",26.071199999999997,26.071199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87425,null,"See CPT",17.011600000000001,17.011600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87475,null,"See CPT",28.471,28.471,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87491,null,"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87500,null,"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87520,null,"See CPT",44.332399999999993,44.332399999999993,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87525,null,"See CPT",42.315999999999995,42.315999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87532,null,"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87551,null,"See CPT",68.500799999999998,68.500799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87562,null,"See CPT",60.832799999999999,60.832799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87632,null,"See CPT",309.64519999999999,309.64519999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87660,null,"See CPT",28.471,28.471,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87801,null,"See CPT",99.683999999999997,99.683999999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87899,null,"See CPT",22.819399999999998,22.819399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87906,null,"See CPT",182.79659999999998,182.79659999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87999,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[88036,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[88104,26,"See CPT",48.227400000000003,48.227400000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88120,26,"See CPT",103.5996,103.5996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88147,null,"See CPT",71.795199999999994,71.795199999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88160,"TC","See CPT",95.26400000000001,95.26400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88172,null,"See CPT",103.0042,103.0042,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88175,null,"See CPT",37.786199999999994,37.786199999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88177,"TC","See CPT",15.480399999999999,15.480399999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88230,null,"See CPT",165.41579999999999,165.41579999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88245,null,"See CPT",245.90139999999997,245.90139999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88283,null,"See CPT",97.411999999999992,97.411999999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88302,26,"See CPT",11.908000000000001,11.908000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88307,null,"See CPT",547.17259999999999,547.17259999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88313,null,"See CPT",155.39939999999999,155.39939999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88319,"TC","See CPT",208.9854,208.9854,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88323,null,"See CPT",209.58080000000001,209.58080000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88333,26,"See CPT",110.7444,110.7444,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88341,26,"See CPT",50.013599999999997,50.013599999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88348,26,"See CPT",137.53739999999999,137.53739999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88356,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88362,null,"See CPT",426.90179999999998,426.90179999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88366,26,"See CPT",110.149,110.149,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88369,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88371,26,"See CPT",34.533199999999994,34.533199999999994,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[88377,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88381,26,"See CPT",42.273399999999995,42.273399999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88740,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89060,26,"See CPT",31.5562,31.5562,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[89255,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89291,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[89329,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[89335,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90291,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90375,null,"See CPT",336.2,336.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
[90461,null,"See CPT",18.4574,18.4574,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,16]
[90581,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90644,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90660,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90670,null,"See CPT",257.99,257.99,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90673,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90698,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,17]
[90707,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,17]
[90738,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,17]
[90748,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,17]
[90838,null,"See CPT",208.9854,186.36019999999999,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM",2,17]
[90869,null,"See CPT",498.85639800000001,498.85639800000001,"000",0,0,0,0,0,0,1,0,0,null,"F",null,"Y-CM",2,17]
[90887,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,17]
[90901,null,"See CPT",76.806600000000003,33.937799999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,6]
[90959,null,"See CPT",584.0874,584.0874,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[90962,null,"See CPT",364.98019999999997,364.98019999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[90999,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
[91020,null,"See CPT",521.57039999999995,521.57039999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91035,null,"See CPT",881.19200000000001,881.19200000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91038,"TC","See CPT",682.32839999999999,682.32839999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91111,"TC","See CPT",1633.7776000000001,1633.7776000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91113,null,"See CPT",1745.1173999999999,1745.1173999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91200,null,"See CPT",57.1584,57.1584,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91299,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2]
[91314,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[92018,null,"See CPT",250.6634,250.6634,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92066,null,"See CPT",49.418199999999999,49.418199999999999,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2]
[92082,"TC","See CPT",50.013599999999997,50.013599999999997,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92134,26,"See CPT",44.655000000000001,44.655000000000001,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92136,"TC","See CPT",32.747,32.747,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92240,null,"See CPT",360.81239999999997,360.81239999999997,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM",2]
[92242,null,"See CPT",491.20499999999998,491.20499999999998,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM",2]
[92283,"TC","See CPT",86.332999999999998,86.332999999999998,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM",2]
[92285,null,"See CPT",43.464199999999998,43.464199999999998,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92315,null,"See CPT",155.9948,38.105600000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92342,null,"See CPT",77.997399999999999,47.0366,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2]
[92504,null,"See CPT",54.776800000000001,17.266599999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92511,null,"See CPT",223.87039999999999,69.066399999999987,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92537,null,"See CPT",74.424999999999997,74.424999999999997,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[92538,null,"See CPT",41.677999999999997,41.677999999999997,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[92545,26,"See CPT",23.816000000000003,23.816000000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92546,26,"See CPT",26.792999999999999,26.792999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,29]
[92553,null,"See CPT",83.355999999999995,83.355999999999995,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2,29]
[92565,null,"See CPT",38.105600000000003,38.105600000000003,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2,29]
[92584,null,"See CPT",212.55779999999999,212.55779999999999,"000",0,0,0,0,0,2,0,0,0,null,"R",null,null,2,29]
[92587,26,"See CPT",32.747,32.747,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,29]
[92605,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-CM",2,26]
[92608,null,"See CPT",89.9054,89.9054,"000",0,0,0,7,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[92630,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[92650,null,"See CPT",51.799799999999998,51.799799999999998,"000",0,0,0,0,0,2,0,0,0,null,"R",null,"Y-CM",2,26]
[92934,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[92953,null,"See CPT",1.7862,1.7862,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[92979,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[92998,null,"See CPT",549.55420000000004,549.55420000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93025,"TC","See CPT",162.54419999999999,162.54419999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93041,null,"See CPT",11.3126,11.3126,"000",0,0,0,3,6,0,0,0,0,null,"R",null,null,2,26]
[93248,null,"See CPT",46.441200000000002,46.441200000000002,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93260,"TC","See CPT",67.280199999999994,67.280199999999994,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93279,null,"See CPT",127.41560000000001,127.41560000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93281,26,"See CPT",75.020399999999995,75.020399999999995,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93285,"TC","See CPT",68.470999999999989,68.470999999999989,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93287,26,"See CPT",39.891800000000003,39.891800000000003,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93291,26,"See CPT",32.151600000000002,32.151600000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93292,26,"See CPT",36.9148,36.9148,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93306,"TC","See CPT",247.09100000000001,247.09100000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93307,"TC","See CPT",179.8108,179.8108,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93315,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93318,null,"See CPT","By Report","By Report","000",0,0,0,1,6,0,0,0,0,null,"N",null,null,2,26]
[93325,26,"See CPT",5.3586,5.3586,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[93352,null,"See CPT",63.707800000000006,63.707800000000006,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[93454,null,"See CPT",1707.0118,1707.0118,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93455,null,"See CPT",1900.5168000000001,1900.5168000000001,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93460,"TC","See CPT",1690.9359999999999,1690.9359999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93461,"TC","See CPT",1863.6020000000001,1863.6020000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93503,null,"See CPT",154.804,154.804,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[93571,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93590,null,"See CPT",1892.7765999999999,1892.7765999999999,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR",2,26]
[93594,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[93598,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[93600,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93612,26,"See CPT",278.6472,278.6472,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93615,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93619,null,"See CPT","By Report","By Report","000",0,0,0,1,2,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93623,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93641,null,"See CPT","By Report","By Report","000",0,0,0,1,2,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93644,26,"See CPT",254.23579999999998,254.23579999999998,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93662,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93724,"TC","See CPT",89.31,89.31,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93793,null,"See CPT",20.838999999999999,20.838999999999999,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93799,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93882,"TC","See CPT",192.90960000000001,192.90960000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93892,"TC","See CPT",500.73140000000001,500.73140000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93923,"TC","See CPT",204.8176,204.8176,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93925,26,"See CPT",66.68480000000001,66.68480000000001,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93970,26,"See CPT",58.944600000000001,58.944600000000001,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93976,null,"See CPT",300.67699999999996,300.67699999999996,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93981,null,"See CPT",132.17880000000002,132.17880000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93985,null,"See CPT",471.55680000000001,471.55680000000001,"000",0,0,0,1,6,2,0,0,0,null,"R",null,"Y-CM",2,26]
[93990,"TC","See CPT",236.9692,236.9692,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[94013,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[94150,26,"See CPT",0,0,"000",0,0,0,1,9,9,9,9,9,null,"B",null,null,2]
[94450,null,"See CPT",154.804,154.804,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94619,null,"See CPT",143.4914,143.4914,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-ONC",2]
[94642,null,"See CPT","By Report","By Report","000",0,0,0,5,0,0,0,0,0,null,"N",null,null,2]
[94681,null,"See CPT",88.714600000000004,88.714600000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94690,null,"See CPT",90.500799999999998,90.500799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94727,"TC","See CPT",60.730800000000002,60.730800000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94772,26,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
[94781,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2]
[95052,null,"See CPT",11.908000000000001,11.908000000000001,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[95131,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
[95147,null,"See CPT",112.53059999999999,5.3586,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95706,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95709,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95716,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95782,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
[95800,26,"See CPT",72.638800000000003,72.638800000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95806,26,"See CPT",78.592799999999997,78.592799999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95811,26,"See CPT",219.10720000000001,219.10720000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95816,null,"See CPT",728.76959999999997,728.76959999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95829,null,"See CPT",3365.2008000000001,3365.2008000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95857,null,"See CPT",116.69839999999999,51.2044,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[95860,26,"See CPT",90.500799999999998,90.500799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95865,"TC","See CPT",132.17880000000002,132.17880000000002,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95868,null,"See CPT",261.38059999999996,261.38059999999996,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95873,null,"See CPT",136.3466,136.3466,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95886,null,"See CPT",182.78779999999998,182.78779999999998,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95905,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
[95910,26,"See CPT",188.1464,188.1464,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95912,"TC","See CPT",178.02460000000002,178.02460000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95913,"TC","See CPT",196.482,196.482,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95924,26,"See CPT",155.9948,155.9948,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95926,26,"See CPT",48.822799999999994,48.822799999999994,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95930,null,"See CPT",125.62939999999999,125.62939999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95940,null,"See CPT",57.753799999999998,57.753799999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[95955,26,"See CPT",94.668599999999998,94.668599999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95962,"TC","See CPT",194.69579999999999,194.69579999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95967,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95970,null,"See CPT",33.937799999999996,33.342400000000005,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[95991,null,"See CPT",207.19919999999999,71.447999999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-UR",2]
[96004,null,"See CPT",194.69579999999999,194.69579999999999,"000",0,0,0,2,0,2,0,0,0,null,"R",null,"Y-CM",2]
[96127,null,"See CPT",8.9309999999999992,8.9309999999999992,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,25]
[96138,null,"See CPT",64.898600000000002,64.898600000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,25]
[96170,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,17]
[96371,null,"See CPT",107.76739999999999,107.76739999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,25]
[96379,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,25]
[96405,null,"See CPT",158.37640000000002,52.395200000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,25]
[96440,null,"See CPT",1436.1048000000001,242.32780000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,25]
[96549,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,21]
[96920,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
[96935,null,"See CPT",149.44539999999998,149.44539999999998,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2,10]
[97032,null,"See CPT",26.197600000000001,26.197600000000001,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,23]
[97130,null,"See CPT",39.296399999999998,39.296399999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,25]
[97154,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,25]
[97157,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,25]
[97171,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,25]
[97545,null,"See CPT",165.68732367158398,165.68732367158398,"000",0,0,0,7,0,0,0,0,0,null,"F",null,"Y-CM",2,10]
[97760,null,"See CPT",91.096199999999996,91.096199999999996,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,10]
[97810,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,10]
[98943,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[98977,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99024,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,10]
[99050,null,"See CPT",53.180588672640013,50.455359336096002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,10]
[99135,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,10]
[99152,null,"See CPT",94.668599999999998,22.029799999999998,"000",0,0,0,9,9,9,9,9,9,null,"R",null,"Y-CM",2,10]
[99184,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99202,null,"See CPT",132.77420000000001,86.332999999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99231,null,"See CPT",88.714600000000004,88.714600000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99252,null,"See CPT",128.60640000000001,128.60640000000001,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99284,null,"See CPT",214.34399999999999,214.34399999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99291,null,"See CPT",497.15899999999999,380.4606,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99348,null,"See CPT",136.94199999999998,136.94199999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99358,null,"See CPT",0,0,"000",0,0,0,0,0,0,0,0,0,null,"B",null,null,2,10]
[99381,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99391,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99407,null,"See CPT",50.013599999999997,44.655000000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[99417,null,"See CPT",55.967599999999997,54.181400000000004,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2]
[99441,null,"See CPT",103.0042,62.517000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,23]
[99446,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,23]
[99463,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99466,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99479,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99489,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99501,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[99509,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0002A",null,"See CPT",40,40,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["0011A",null,"See CPT",40,40,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["0015F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0016M",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0041A",null,"See CPT",40,40,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["0071T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0086U",null,"See CPT",284,284,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["0093U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0101T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0102U",null,"See CPT",1851.6089999999999,1851.6089999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC",2]
["0114U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0117U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0132U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0134U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0145U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0152U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0161U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0164T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0208T",null,"See CPT","By Report","By Report","000",0,0,0,3,0,0,0,0,0,null,"N",null,null,2]
["0210T",null,"See CPT","By Report","By Report","000",0,0,0,3,0,0,0,0,0,null,"N",null,null,2]
["0218T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,1,0,0,0,null,"N",null,"Y-UR",2]
["0219U",null,"See CPT",1029.5,1029.5,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["0228U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0234T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
["0241U",null,"See CPT",202.53459999999998,202.53459999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["0264T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0288U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0291U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0304R",null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["0308T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2]
["0348T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0355U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0375R",null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["0389R",null,"See CPT",12.52281496752,12.52281496752,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0402T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0404T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0414T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0416T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0427T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0434T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0445T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
["0472T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0490T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0496T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,0,9,9,9,9,null,"X",null,null,2]
["0512T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0514F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0518T",null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-CM",2]
["0526F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0535F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0540T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0553T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0555T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0567T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0570T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0582F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0584T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0622T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2]
["0629T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,2,0,0,0,null,"X",null,null,2]
["0672T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0675T",null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-UR",2]
["0691T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["0694T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["0701T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2]
["0739T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,2,0,0,null,"X",null,null,2]
["0751T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
["0758T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
["0770T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
["0777T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["0809V",null,"See CPT",8.8597536730559998,8.8597536730559998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,12]
["0812V",null,"See CPT",10.393384757184004,10.393384757184004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,12]
["0840V",null,"See CPT",10.393384757184004,10.393384757184004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0896V",null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["1010F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1026F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1038M",null,"Revw job offer/analysis for empl,per job",58.928946908832003,58.928946908832003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["1046M",null,"Provider travel per mile, round trip exc",5.8145581391040002,5.8145581391040002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,22]
["1066M",null,"Provider review of video materials with report","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,27]
["1067M","TF","Assessment Impediments RTW (Moderate)","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1074M",null,"AP response to vrc/employer request re: RTW",36.266513478624006,36.266513478624006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["1100F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1111F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1125F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,12]
["1136F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1144M",null,"IME No show ",390.0684,390.0684,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,13]
["1155M",null,"Record rvw and rpt by cons w/o pt, opioid use","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1157M",null,"Omd contracted consultant claim review","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1170F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1200F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1222M",null,"Nurse case mgmt case planning per unit",12.83,12.83,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["1249M",null,"UR, advanced imaging re-review & alternate criteria review","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1304W",null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["1451F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1505F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1726M",null,"PGAP Coordination 11-20 Minutes",43.464199999999998,39.296399999999998,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,22]
["2004F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2021F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2028F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2060F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3017F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3025F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3050F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3062F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3073F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3089F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3100F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3140F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3200F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3269F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3288F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3301F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3317F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3340F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3351F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3386F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3475F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3495F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3515F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3570F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3650F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3760F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4001F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4017F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4037F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4051F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4066F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4079F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4090F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4135F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4149F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4168F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4177F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4191F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4240F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4260F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4266F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4320F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,28]
["4340F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,28]
["4550F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4557F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["5050F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["6010F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["6100F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["6110F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["8893H",null,"See CPT",187.77050795131203,187.77050795131203,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["8901H",null,"See CPT",15.153179410512001,15.153179410512001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["9001F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["9915M",null,"IND HYGIENIST OFFICE VISIT",222.00585804000002,222.00585804000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["9981M",null,"OVER PHONE INTERPRETING TIER 2","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2,14]
["A0160",null,"Noner transport case worker","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A0380",null,"Basic life support mileage",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A0390",null,"Advanced life support mileag",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A0433",null,"Als 2",1140.8718761940411,1140.8718761940411,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A0436",null,"Rotary wing air mileage",87.587085685808987,87.587085685808987,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A2009",null,"Symphony, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A2016",null,"Permeaderm b, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4211",null,"Supp for self-adm injections",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4220",null,"Infusion pump refill kit",69.380200000000002,69.380200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28]
["A4235",null,"Lithium batt for glucose mon",7.7243999999999993,7.7243999999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4239",null,"Non-adju cgm supply allow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4258",null,"Lancet device each",2.1624000000000003,2.1624000000000003,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4267",null,"Male condom","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4300",null,"Cath impl vasc access portal",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4313",null,"Catheter w/bag 3-way",23.276400000000002,23.276400000000002,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4332",null,"Lube sterile packet",0.153,0.153,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4340",null,"Indwelling catheter special",43.064399999999999,43.064399999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4357",null,"Bedside drainage bag",13.168200000000001,13.168200000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4361",null,"Ostomy face plate",24.908400000000004,24.908400000000004,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4380",null,"Urinary rubber pouch w fcplt",50.643000000000001,50.643000000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4383",null,"Urinary rubber pouch w/o fp",38.239800000000002,38.239800000000002,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4396",null,"Peristomal hernia supprt blt",54.906599999999997,54.906599999999997,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4406",null,"Pectin based ostomy paste",7.7622000000000009,7.7622000000000009,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4418",null,"Ost pch clsd w/o bar w filtr",2.4582000000000002,2.4582000000000002,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4425",null,"Ost pch drain for barrier fl",4.8552,4.8552,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4437",null,"Irr supply sleev disp per mo",26.01,26.01,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4453",null,"Rec cath man pump enema repl","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A4510",null,"Full length surg stocking",131.405,131.405,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4553",null,"Nondisp underpads, all sizes","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4590",null,"Special casting material","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4600",null,"Sleeve, inter limb comp dev",44.148800000000001,44.148800000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4616",null,"Tubing (oxygen) per foot",8.1600000000000006E-2,8.1600000000000006E-2,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4625",null,"Trach care kit for new trach",8.8637999999999995,8.8637999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4639",null,"Infrared ht sys replcmnt pad","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4642",null,"In111 satumomab","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,28]
["A4690",null,"Dialyzer, each",197.63640000000001,197.63640000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28]
["A4708",null,"Acetate conc sol per gallon","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A4750",null,"Art or venous blood tubing",78.843000000000004,78.843000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4765",null,"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]
["A4913",null,"Misc dialysis supplies noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A4932",null,"Reusable rectal thermometer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A5072",null,"Urinary pouch w/o barrier",4.7940000000000005,4.7940000000000005,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A5105",null,"Urinary suspensory",55.304400000000001,55.304400000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A5503",null,"Diabetic shoe w/roller/rockr",43.921200000000006,43.921200000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,28]
["A5506",null,"Diabetic shoe w/off set heel",43.921200000000006,43.921200000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,28]
["A6196",null,"Alginate dressing <=16 sq in",9.9857999999999993,9.9857999999999993,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6199",null,"Alginate drsg wound filler",7.1604000000000001,7.1604000000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6214",null,"Foam drg > 48 sq in w/border",13.963799999999999,13.963799999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6221",null,"Gauze > 48 sq in w/border",9.6185999999999989,9.6185999999999989,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6236",null,"Hydrocolld drg > 48 in w/o b",36.964800000000004,36.964800000000004,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6243",null,"Hydrogel drg >16<=48 w/o bdr",16.7178,16.7178,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6256",null,"Absorpt drg > 48 sq in w/bdr",5.2561999999999998,5.2561999999999998,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6259",null,"Transparent film > 48 sq in",14.8308,14.8308,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6444",null,"Conform band n/s w>=5\"/yd",0.75480000000000003,0.75480000000000003,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6447",null,"Conform band s w >=5\"/yd",0.92820000000000003,0.92820000000000003,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6461",null,"Synthetic drsg >16<=48 sq in","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A6507",null,"Cmprs burngarment foot-knee",210.24799999999996,210.24799999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A6535",null,"Gc stocking thighlngth 40-50",115.63639999999999,115.63639999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A6544",null,"Gc stocking garter belt",113.5372,113.5372,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7006",null,"Filtered nebulizer admin set",19.450399999999998,19.450399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7009",null,"Nebulizer reservoir bottle",105.12399999999998,105.12399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7031",null,"Replacement facemask interfa",79.523600000000002,79.523600000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7034",null,"Nasal application device",145.29579999999999,145.29579999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7041",null,"Water seal drain container",100.6332,100.6332,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7521",null,"Trach/laryn tube cuffed",63.811200000000007,63.811200000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A8001",null,"Hard protect helmet prefab",296.26235429040008,296.26235429040008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A9155",null,"Artificial saliva","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["A9281",null,"Reaching/grabbing device",37.490399999999994,37.490399999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A9284",null,"Non-electronic spirometer",17.662799999999997,17.662799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A9513",null,"Lutetium lu 177 dotatat ther","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["A9517",null,"I131 iodide cap, rx","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9529",null,"I131 iodide sol, dx","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9546",null,"Co57/58","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9559",null,"Co57 cyano","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9567",null,"Technetium tc-99m aerosol","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9580",null,"Sodium fluoride f-18","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9587",null,"Gallium ga-68","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["A9599",null,"Radioph dx b amyloid pet nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["A9602",null,"Fluorodopa f-18 diag per mci",89.8,89.8,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,9]
["A9800",null,"Gallium locametz 1 millicuri","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["B4100",null,"Food thickener oral",5.0675999999999997,5.0675999999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2]
["B4158",null,"Ef ped complete intact nut","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM",2]
["B4172",null,"Parenteral sol amino acid 5.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2]
["B4222",null,"Parenteral supply kit homemi",13.912800000000001,13.912800000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2]
["B9004","NU","Parenteral infus pump portab",3554.1084000000001,3554.1084000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["C1717",null,"Brachytx, non-str,hdr ir-192","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C1722",null,"Aicd, single chamber",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1730",null,"Cath, ep, 19 or few elect",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1754",null,"Catheter, intradiscal",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1766",null,"Intro/sheath,strble,non-peel",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1773",null,"Ret dev, insertable",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1787",null,"Patient progr, neurostim",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1817",null,"Septal defect imp sys",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1831",null,"Personalized interbody cage","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["C1839",null,"Iris prosthesis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["C1880",null,"Vena cava filter",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1893",null,"Intro/sheath, fixed,non-peel",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1900",null,"Lead, coronary venous",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C2622",null,"Prosthesis, penile, non-inf",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C2636",null,"Brachy linear, non-str,p-103","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C2643",null,"Brachytx, non-stranded,c-131","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C5278",null,"Low cost skin substitute app","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C7502",null,"Perc bx breast lesions mr","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7509",null,"Dx bronch w/ navigation","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7521",null,"R hrt angio w/ ivus or oct","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7528",null,"R&l hrt angio w/flow resrv","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7541",null,"Ercp w/ pancreatoscopy","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C7553",null,"R&i hrt art/vent ang drg ad","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C8901",null,"Mra w/o cont, abd",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C8918",null,"Mra w/cont, pelvis",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C8921",null,"Tte w or w/o fol w/cont, com","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C8928",null,"Tte w or w/o fol w/con,stres",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9041",null,"Inj, coagulation factor xa",353.63196000000005,353.63196000000005,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9057",null,"Inj cetirizine hydrochloride","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["C9144",null,"Inj, bupivacaine (posimir)","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["C9293",null,"Injection, glucarpidase","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["C9362",null,"Implnt,bon void filler-strip",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9485",null,"Injection, olaratumab","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["C9602",null,"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]
["C9605",null,"Perc d-e cor revasc t cabg b","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9740",null,"Cysto impl 4 or more","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9759",null,"Transcath intraop microinf","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2]
["C9771",null,"Nsl/sins cryo post nasal tis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2]
["C9783",null,"Blind cor sinus reducer impl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["D0150",null,"Comprehensve oral evaluation",113.6,113.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D0251",null,"Extraoral posterior image",82.4,82.4,"000",0,0,0,1,0,0,0,0,0,null,"F",null,null,2,8]
["D0320",null,"Dental tmj arthrogram incl i",669.6,669.6,"000",0,0,0,1,0,0,0,0,0,null,"F",null,null,2,8]
["D0330",null,"Panoramic image",139.19999999999999,139.19999999999999,"000",0,0,0,1,0,0,0,0,0,null,"F",null,null,2,8]
["D0373",null,"Tomo bitewing image","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D0385",null,"Max mri image capture",633.6,633.6,"000",0,0,0,1,4,0,0,0,0,null,"F",null,null,2,8]
["D0415",null,"Collection of microorganisms","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D0425",null,"Caries susceptibility test","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D0480",null,"Cytopath smear prep & report","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,8]
["D0604",null,"Antigen test pub hlth pathog","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,"Y-ONC",2,8]
["D0706",null,"Intraoral occlus radio image","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,8]
["D0709",null,"Intraoral cmplt radio images","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,8]
["D1321",null,"Couns for high risk sub use","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D1510",null,"Space maintainer fxd unilat",367.2,367.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D1575",null,"Dist space maint, fixed unil",436,436,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D1707",null,"Janssen Covid-19 vaccine administration","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2335",null,"Resin 4/> surf or w incis an",387.2,387.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D2542",null,"Dental onlay metallic 2 surf","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X",null,null,2,8]
["D2643",null,"Dental onlay porcelin 3 surf","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X",null,null,2,8]
["D2651",null,"Inlay composite/resin two su","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X",null,null,2,8]
["D2751",null,"Crown porcelain fused base m",1254.4000000000001,1254.4000000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D2790",null,"Crown full cast high noble m",1431.2,1431.2,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D2931",null,"Prefab stnlss steel crown pe",388,388,"000",0,0,0,5,0,0,0,0,0,null,"F",null,null,2,8]
["D2950",null,"Core build-up incl any pins",326.39999999999998,326.39999999999998,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D2980",null,"Crown repair",343.2,343.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D3240",null,"Pulpal therapy posterior pri","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D3346",null,"Retreat root canal anterior",1064.8,1064.8,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D3351",null,"Apexification/recalc initial",446.4,446.4,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,null,2,8]
["D3460",null,"Endodontic endosseous implan",1811.2,1811.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D3472",null,"Surg rep root res premolar",800.8,800.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D4211",null,"Gingivectomy/plasty 1 to 3",425.6,425.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D4249",null,"Crown lengthen hard tissue",961.6,961.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D4275",null,"Non-auto graft 1st tooth",1292,1292,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D4355",null,"Full mouth debridement","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D5120",null,"Dentures complete mandible",2169.6,2169.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D5211",null,"Dentures maxill part resin",1700.8,1700.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5410",null,"Dentures adjust cmplt maxil",113.6,113.6,"000",0,0,0,5,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D5422",null,"Dentures adjust part mandbl",113.6,113.6,"000",0,0,0,5,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D5670",null,"Replc tth&acrlc on mtl frmwk",893.6,893.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5730",null,"Denture reln cmplt maxil ch",459.2,459.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5821",null,"Denture interm part mandbl",860.8,860.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5866",null,"Overdenture partial mandib",2743.2,2743.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5922",null,"Nasal septal prosthesis","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D5925",null,"Facial augmentation implant","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D5955",null,"Palatal lift prosthesis","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D5983",null,"Radiation applicator","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D5999",null,"Maxillofacial prosthesis",1880,1880,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D6051",null,"Interim abutment",668,668,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D6066",null,"Implant supported mtl crown",1782.4,1782.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6073",null,"Abutment supported retainer",1578.4,1578.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6088",null,"Imp crown titanium alloys",1856.8,1856.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D6092",null,"Recement supp crown",187.2,187.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D6110",null,"Implnt/abut remov dent max",3969.6,3969.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D6113",null,"Imp/abut rem dent part mand",3446.4,3446.4,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D6191",null,"Semi precision abutment",797.6,797.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-ONC",2,8]
["D6205",null,"Pontic-indirect resin based",1163.2,1163.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6252",null,"Bridge resin w/noble metal",1237.5999999999999,1237.5999999999999,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6602",null,"Cst hgh nble mtl inlay 2 srf","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D6614",null,"Onlay cst nbl mtl 2 surfaces","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D6634",null,"Onlay titanium","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D6791",null,"Crown full base metal cast",1229.5999999999999,1229.5999999999999,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6794",null,"Crown titanium",1291.2,1291.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D7251",null,"Coronectomy",556.79999999999995,556.79999999999995,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D7270",null,"Tooth reimplantation",672,672,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D7293",null,"Temp anchorage dev w flap",2746.4,2746.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D7300",null,"Rem anchorage dev w/o flap","By Report","By Report","000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM",2,8]
["D7415",null,"Excision malig les complicat","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,1,1,0,0,null,"X",null,null,2,8]
["D7450",null,"Rem odontogen cyst to 1.25cm",749.6,749.6,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"F",null,"Y-CM",2,8]
["D7540",null,"Removal of fb reaction",754.4,754.4,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7957",null,"Tiss regen edent nonresorb","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D7770",null,"Open reduc compd alveolus fx",3110.4,3110.4,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"F",null,"Y-CM",2,8]
["D7810",null,"Tmj open reduct-dislocation",5166.3999999999996,5166.3999999999996,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7871",null,"Lysis + lavage w catheters",1100,1100,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7880",null,"Occlusal orthotic appliance",1292.8,1292.8,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7944",null,"Bone cutting segmented",8096,8096,"000",0,0,0,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7947",null,"Reconstruct maxilla segment",10245.6,10245.6,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7980",null,"Surgical sialolithotomy","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D7983",null,"Closure of salivary fistula",1868.8,1868.8,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D8090",null,"Compre dental tx adult",5513.6,5513.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D8660",null,"Preorthodontic tx visit",495.2,495.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D8704",null,"Replace broken retainer man",352,352,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D9212",null,"Trigeminal block anesthesia",0,0,"000",0,0,0,0,0,0,0,0,0,null,"B",null,null,2,8]
["D9420",null,"Hospital/asc call",368,368,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9630",null,"Drugs/meds disp for home use",55.2,55.2,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9943",null,"Occlusal guard adjustment",157.60000000000002,157.60000000000002,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9946",null,"Occ guard, hard, part arch",635.20000000000005,635.20000000000005,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D9986",null,"Missed appointment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D9991",null,"Case mgmt, appt barriers",104.80000000000001,104.80000000000001,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["E0112","NU","Crutch underarm pair wood",50.2044,50.2044,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0130","RR","Walker rigid adjust/fixed ht",11.8422,11.8422,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0147","RR","Walker variable wheel resist",59.690400000000004,59.690400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0154","NU","Walker platform attachment",72.521999999999991,72.521999999999991,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0160","NU","Sitz type bath or equipment",40.881599999999999,40.881599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0163","NU","Commode chair with fixed arm",108.5484,108.5484,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0184","RR","Dry pressure mattress",26.948400000000003,26.948400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0186","NU","Air pressure mattress",257.24399999999997,257.24399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0191","NU","Protector heel or elbow",11.515799999999999,11.515799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0203",null,"Therapeutic lightbox tabletp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0239",null,"Hydrocollator unit portable","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0245","NU","Tub stool or bench",96.993891083232015,96.993891083232015,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0256","RR","Hospital bed var ht w/o matt",86.751000000000005,86.751000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0261","NU","Hosp bed semi-electr w/o mat",1192.1759999999999,1192.1759999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0277","RR","Powered pres-redu air mattrs",534.38819999999998,534.38819999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0290","NU","Hosp bed fx ht w/o rails w/m",801.51600000000008,801.51600000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0293","RR","Hosp bed var ht no sr no mat",77.142600000000002,77.142600000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0302","NU","Ex hd hosp bed > 600 lbs",7191.2039999999997,7191.2039999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0316","NU","Bed safety enclosure",2390.37,2390.37,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0352","NU","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","Portable gaseous 02",29.9268,29.9268,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0435",null,"Oxygen system liquid portabl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0462","NU","Rocking bed w/ or w/o side r",3359.9820000000004,3359.9820000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0465","RR","Home vent invasive interface",1100.5698,1100.5698,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0471","RR","Rad w/backup non inv intrfc",548.90279999999996,548.90279999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0485","NU","Oral device/appliance prefab",220.74399999999997,220.74399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0570","RR","Nebulizer with compression",14.6166,14.6166,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0580","NU","Nebulizer for use w/ regulat",156.51899999999998,156.51899999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0607","NU","Blood glucose monitor home",90.637200000000007,90.637200000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0617","RR","Automatic ext defibrillator",412.41660000000002,412.41660000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0629","RR","Seat lift mech, non-electric",58.02,58.02,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0635","NU","Patient lift electric",4296.78,4296.78,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0639","NU","Moveable patient lift system","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0652","NU","Pneum compres w/cal pressure",6543.3714,6543.3714,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0666","NU","Pneumatic appliance half leg",187.32300000000001,187.32300000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0669","RR","Seg pneumatic appli half leg",24.867599999999999,24.867599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0677",null,"Non pneum seq comp trunk","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0705","RR","Transfer device",6.7524000000000006,6.7524000000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0748","NU","Elec osteogen stim spinal",5277.6228000000001,5277.6228000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["E0749","RR","Elec osteogen stim implanted",376.87979999999999,376.87979999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["E0764","NU","Functional neuromuscularstim",15011.544000000002,15011.544000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0781","RR","External ambulatory infus pu",325.00259999999997,325.00259999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["E0791","RR","Parenteral infusion pump sta",387.14100000000002,387.14100000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0850","NU","Traction stand free standing",142.494,142.494,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0890","RR","Traction frame attach pelvic",44.533200000000001,44.533200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0912","NU","Hd trapeze bar free standing",1191.462,1191.462,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0944","NU","Pelvic belt/harness/boot",57.864599999999996,57.864599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0947","RR","Fracture frame attachmnts pe",84.802800000000005,84.802800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0953","RR","W/c lateral thigh/knee sup",10.577399999999999,10.577399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0959","RR","Amputee adapter",5.8038000000000007,5.8038000000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0967","NU","Man wc rim/projection rep ea",89.086800000000011,89.086800000000011,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0974","NU","W/ch access anti-rollback",99.409199999999998,99.409199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0984","NU","Add pwr tiller",2591.4120000000003,2591.4120000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0990","NU","Wheelchair elevating leg res",102.56099999999999,102.56099999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1004","NU","Pwr seat recline mech",5637.03,5637.03,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1005","RR","Pwr seat recline pwr",613.37700000000007,613.37700000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1009","NU","Add mech leg elevation","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1020","RR","Residual limb support system",25.530600000000003,25.530600000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1031","NU","Rollabout chair with casters",612.10199999999998,612.10199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1060","RR","Wheelchair detachable arms",168.52440000000001,168.52440000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1087","RR","Wheelchair lightwt fixed arm",166.42320000000001,166.42320000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1092","NU","Wheelchair wide w/ leg rests",1743.2820000000002,1743.2820000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1150","NU","Wheelchair standard w/ leg r",1106.4960000000001,1106.4960000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1171","NU","Wheelchair amputee w/o leg r",1087.2180000000001,1087.2180000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1172","RR","Wheelchair amputee detach ar",132.90600000000001,132.90600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1222","NU","Wheelchair spec size w/ leg",919.32599999999991,919.32599999999991,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1225","RR","Manual semi-reclining back",54.417000000000002,54.417000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1234",null,"Fld ped wc tltnspc w/o seat","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1270","NU","Wheelchair lightweight leg r",1070.796,1070.796,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1290","RR","Wheelchair hvy duty detach a",242.8184,242.8184,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1353","RR","Oxygen supplies regulator",26.838599999999996,26.838599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1372","RR","Oxy suppl heater for nebuliz",23.980200000000004,23.980200000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1392","RR","Portable oxygen concentrator",51.448799999999999,51.448799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1570","RR","Adjustable chair for esrd pt","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1610","RR","Reverse osmosis h2o puri sys",36.120999999999995,36.120999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1699","NU","Dialysis equipment noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["E1812","RR","Knee ext/flex w act res ctrl",116.6472,116.6472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1830","RR","Adjust toe ext/flex device",171.39060000000001,171.39060000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2201","NU","Man w/ch acc seat w>=20\"<24\"",445.92360000000002,445.92360000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2204","RR","Frame depth 22 to 25 in",101.1738,101.1738,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2206","NU","Man wc whl lock comp repl ea",51.428400000000003,51.428400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2214","NU","Pneumatic caster tire each",44.869800000000005,44.869800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2221","NU","Solid caster tire repl, each",33.945599999999999,33.945599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2231","RR","Solid seat support base",19.114799999999999,19.114799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2300","RR","Pwr seat elevation sys","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["E2321","RR","Hand interface joystick",179.214,179.214,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2327","RR","Head control interface mech",305.15340000000003,305.15340000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2331","NU","Attendant control","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["E2340","RR","W/c wdth 20-23 in seat frame",48.633600000000001,48.633600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2360","RR","22nf nonsealed leadacid",13.1172,13.1172,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2364","NU","U1nonsealed leadacid battery",141.6576,141.6576,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2370","NU","Pwr wc dr wh motor/gear comb",801.51600000000008,801.51600000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2374","RR","Hand/chin ctrl std joystick",60.496200000000002,60.496200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2383","NU","Insert, pneum wheel drive",168.83040000000003,168.83040000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2389","NU","Foam caster tire",31.568999999999999,31.568999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2392","RR","Solid caster tire, integrate",5.8140000000000001,5.8140000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2395","NU","Caster wheel excludes tire",59.180400000000006,59.180400000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2506","RR","Sgd prerec msg > 40 min",313.73160000000001,313.73160000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2510","NU","Sgd w multi methods msg/accs",9180.9179999999997,9180.9179999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2605","NU","Position wc cush wdth <22 in",288.97620000000001,288.97620000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2612","NU","Gen use back cush wdth>=22in",438.42660000000001,438.42660000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2625","NU","Adj skin pro/pos wc cus>=22",476.15640000000002,476.15640000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["G0008",null,"Admin influenza virus vac",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["G0032",null,"2+ antipsy schiz","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0035",null,"Pt ed pos 23","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0051",null,"Pt hospice mnth","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0054",null,"Strk cr prev pos outcme mvp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0066",null,"Clinical social work ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0077",null,"Care manag h vst new pt 30 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0089",null,"Adm subq drug 1st home visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0109",null,"Diab manage trn ind/group",28.5792,28.5792,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
["G0121",53,"Colon ca scrn not hi rsk ind",317.34820000000002,164.3304,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2]
["G0122",26,"Colon ca scrn; barium enema",85.142199999999988,85.142199999999988,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM",2]
["G0152",null,"Hhcp-serv of ot,ea 15 min",46.361998672704019,46.361998672704019,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["G0157",null,"Hhc pt assistant ea 15","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0179",null,"Md recertification hha pt","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,"Y-CM",2]
["G0204","TC","Dx mammo incl cad bi",251.62583096851202,251.62583096851202,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["G0238",null,"Oth resp proc, indiv",19.648199999999999,19.648199999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
["G0250",null,"Md inr test revie inter mgmt",16.075800000000001,16.075800000000001,"000",0,0,0,2,0,0,0,0,0,null,"R",null,null,2]
["G0270",null,"Mnt subs tx for change dx","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0277",null,"Hbot, full body chamber, 30m",325.68379999999996,325.68379999999996,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2]
["G0303",null,"Pre-op service lvrs 10-15dos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["G0306",null,"Cbc/diffwbc w/o platelet",11.033399999999999,11.033399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["G0330",null,"Electromagntic tx for ulcers","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0343",null,"Laparotomy islet cell transp","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X",null,null,2]
["G0397",null,"Alcohol/subs interv >30 min","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0405",null,"Ekg interpret & report preve","Not Covered","Not Covered","000",0,0,0,2,0,0,0,0,0,null,"X",null,null,2]
["G0416","TC","Prostate biopsy, any mthd","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["G0421",null,"Ed svc ckd grp per session",47.632000000000005,47.632000000000005,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G0443",null,"Brief alcohol misuse counsel","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0446",null,"Intens behave ther cardio dx","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0464",null,"Colorec ca scr, sto bas dna","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0471",null,"Ven blood coll snf/hha","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0494",null,"Lpn care ea 15min hh/hospice","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0504",null,"Init/sub psych care add 30 m",132.51013899552004,85.993673882688,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["G0518",null,"Remove w insert drug implant",722.81560000000002,325.68379999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-ONC",2]
["G0915",null,"No improve visual funct","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1016",null,"Cdsm speed of care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1019",null,"Cdsm logicnets","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2007",null,"Post-d/c h vst ext pt 30 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2010",null,"Remot image submit by pt",22.029799999999998,16.671200000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
["G2069",null,"Med assist tx inject","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2076",null,"Intake act w/med exam","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2091",null,"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]
["G2094",null,"Pt rsn no ace arn arni","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2116",null,"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]
["G2122",null,"Psy/dep/anx/apandicd noasse","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2146",null,"Leg pain vas 9-15mo <= 3","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2149",null,"No mpm med rsn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2177",null,"Bronch w rx antibx 30d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2184",null,"No caregiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2196",null,"Screen unhlthy etoh use","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2206",null,"Adjv trtmt chemo her2","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2251",null,"Brief chkin, 5-10, non-e/m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G3003",null,"Brief chkin by md/qhp, 11-22","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G4015",null,"Neurology ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4018",null,"Ob/gyn ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4030",null,"Pulmonology ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4037",null,"Urology ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G6007",null,"Radiation treatment delivery",456.67179999999996,456.67179999999996,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G6014",null,"Radiation treatment delivery",449.52699999999999,449.52699999999999,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G8405",null,"Low extemity neur not perfor","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8416",null,"Pt inelig footwear evaluatio","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8473",null,"Ace/arb thxpy rx'd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8476",null,"Bp sys <140 and dias <90","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8540",null,"Foa not doc as being perf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8562",null,"Pt no hx act drain 90 d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8575",null,"Postop ren fail","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8647",null,"Rafscrs ki scor >= 0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8662",null,"Rafs crs lbi no scor no surv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8666",null,"Rafs crs si no scor no surv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8733",null,"Doc pos elder mal scrn plan","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8749",null,"No signs melanoma","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8785",null,"Bp scrn no perf at interval","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8833",null,"Pt not disch home day#2 evar","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8850",null,"No pap prescribed","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8858",null,"Not ref for oto eval","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8881",null,"Brst cncr stage > t1n0m0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8884",null,"Doc reas biopsy not review","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8934",null,"Lvef <40% or dep lv sys fcn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8937",null,"No rx ace/arb therapy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8955",null,"Most recent assess vol mgmt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8970",null,"No rsk fac or 1 mod risk te","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9012",null,"Other specified case mgmt","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["G9053",null,"Onc expectant management pt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9065",null,"Onc dx nsclc stg3a no progre","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9068",null,"Onc dx sclc/nsclc limited","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9087",null,"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]
["G9090",null,"Onc dx rectal t1-2 no progr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9097",null,"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,"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]
["G9126",null,"Onc dx cml remission","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9134",null,"Onc nhlstg 1-2 no relap no","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9188",null,"Beta not given no reason","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9223",null,"Pjp proph ordered cd4 low","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9254",null,"Doc pt dischg >2d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9274",null,"Bp out of nrml limits","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9281",null,"Pne scrn done doc not ind","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9293",null,"No pt category on report","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9310",null,"Unplnd hosp readm in 30d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9317",null,"No doc comm risk calc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9353",null,"Medrsn >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]
["G9364",null,"Sinus caus bac inx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9396",null,"Ini phq9 >9 not assess","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9404",null,"No 30 day f/u","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9411",null,"No admit w/in 180d req remov","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9423",null,"Med reas rpt no histo type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9430",null,"Spec site no cutaneous","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9459",null,"Tob non-user","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9480",null,"Admission to mccm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9505",null,"Abx pres w/in 10 dys of symp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9518",null,"Doc active inj drug use","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9521",null,"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]
["G9539",null,"Intent pot remv time placemt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9553",null,"Prior thyroid dise dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9593",null,"Low pecarn ped head trauma","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9608",null,"Intraop cyst eval not done","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9627",null,"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,"Elective surgery","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9660",null,"Doc med rsn scope pt >85y","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9676",null,"40-75y w/type 1/2 w/ldl-c rs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9688",null,"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]
["G9700",null,"Pt is w/hosp during msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9708",null,"Bilat mast/hx bi /unilat mas","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9721",null,"Pt not ambul/immob/wc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9733",null,"Pt unbl cmplt lb fs prom","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9744",null,"Pt not eli d/t act dig htn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9761",null,"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]
["G9768",null,"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]
["G9771",null,"Anes end, 1 temp >35.5(95.9)","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9786",null,"Path report not sent","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9793",null,"Pt on daily asa/antiplat","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9820",null,"Doc chlam scr test w/follow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9842",null,"Pt met dis at dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9852",null,"Pt died from cancer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9878",null,"2 em core ms mo 7-9 wl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9890",null,"Em bridge payment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9893",null,"No mac exam","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9906",null,"Pt recv tbco cess interv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9915",null,"No documntd hbv results rcd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9928",null,"No warf or fda drug presc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9943",null,"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]
["G9962",null,"Embolization doc separatly","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9988",null,"Pall serv during meas","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9995",null,"Pall serv during meas","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9998",null,"Doc med rsn <3 colon","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0011",null,"Alcohol and/or drug services","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["H0018",null,"Alcohol and/or drug services","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["H0030",null,"Alcohol and/or drug hotline","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0037",null,"Comm psy sup tx pgm per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0049",null,"Alcohol/drug screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,17]
["H2010",null,"Comprehensive med svc 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2017",null,"Psysoc rehab svc, per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2020",null,"Ther behav svc, per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2032",null,"Activity therapy, per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J0120",null,"Tetracyclin injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0171",null,"Adrenalin epinephrine inject",0.74,0.74,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0190",null,"Inj biperiden lactate/5 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0222",null,"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]
["J0283",null,"Inj, amiodarone (nexterone)","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J0295",null,"Ampicillin sulbactam 1.5 gm",2.17,2.17,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0348",null,"Anidulafungin injection",0.41,0.41,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0485",null,"Belatacept injection",3.79,3.79,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0500",null,"Dicyclomine injection",22.77,22.77,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0574",null,"Bupren/nal 6.1 to 10mg bupre",1.2,1.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0588",null,"Incobotulinumtoxin a",5.2,5.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0606",null,"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]
["J0689",null,"Inj cefazolin sodium, baxter",1.19,1.19,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0697",null,"Sterile cefuroxime injection",2.2400000000000002,2.2400000000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0701",null,"Inj. cefepime hcl (baxter)",5.36,5.36,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,28]
["J0741",null,"Inj, cabote rilpivir 2mg 3mg",21.56,21.56,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0744",null,"Ciprofloxacin iv",1.34,1.34,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0875",null,"Injection, dalbavancin",15.32,15.32,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0893",null,"Inj, decitabine (sun pharma)",1.88,1.88,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0899",null,"Argatroban dialysis, auromed",2.0299999999999998,2.0299999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1110",null,"Inj dihydroergotamine mesylt",57.8,57.8,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1180",null,"Dyphylline injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1201",null,"Inj. cetirizine hcl 0.5mg",15.1,15.1,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1305",null,"Inj, evinacumab-dgnb, 5mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1322",null,"Elosulfase alfa, injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1428",null,"Inj, eteplirsen, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1439",null,"Inj ferric carboxymaltos 1mg",1.1299999999999999,1.1299999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1454",null,"Inj fosnetupitant, palonoset",392.66,392.66,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1551",null,"Inj cutaquig 100 mg",14.15,14.15,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1569",null,"Gammagard liquid injection",46.5,46.5,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1572",null,"Flebogamma injection",44.54,44.54,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1631",null,"Haloperidol decanoate inj",7.65,7.65,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1642",null,"Inj heparin sodium per 10 u",0.02,0.02,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1726",null,"Makena, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1743",null,"Idursulfase injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1817",null,"Insulin for insulin pump use",8.74,8.74,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1850",null,"Kanamycin sulfate 75 mg inj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1952",null,"Leuprolide inj, camcevi, 1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1956",null,"Levofloxacin injection",0.84,0.84,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2185",null,"Meropenem",0.49,0.49,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2247",null,"Inj, micafungin (par pharm)",0.37,0.37,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2320",null,"Nandrolone decanoate 50 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2326",null,"Inj, nusinersen, 0.1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2402",null,"Chloroprocaine (clorotekal)","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J2426",null,"Paliperidone palmitate inj",13.65,13.65,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2513",null,"Pentastarch 10% solution","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2543",null,"Piperacillin/tazobactam",1.34,1.34,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2720",null,"Inj protamine sulfate/10 mg",0.86,0.86,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2730",null,"Pralidoxime chloride inj",86.7,86.7,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2794",null,"Inj risperdal consta, 0.5 mg",11.59,11.59,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2797",null,"Inj., rolapitant, 0.5 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-ONC",2,16]
["J2930",null,"Methylprednisolone injection",5.47,5.47,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2998",null,"Inj plasminogen tvmh 1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3110",null,"Teriparatide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3145",null,"Testosterone undecanoate 1mg",1.85,1.85,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3301",null,"Triamcinolone acet inj nos",1.1200000000000001,1.1200000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3304",null,"Inj triamcinolone ace xr 1mg",16.86,16.86,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J3380",null,"Injection, vedolizumab",21.84,21.84,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3397",null,"Inj., vestronidase alfa-vjbk","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3472",null,"Ovine, 1000 usp units",452.33,452.33,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3490",null,"Drugs unclassified injection","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J7070",null,"D5w infusion",3.38,3.38,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7169",null,"Inj andexxa, 10 mg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,16]
["J7187",null,"Humate-p, inj",1.35,1.35,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7190",null,"Factor viii",1.1299999999999999,1.1299999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7207",null,"Factor viii pegylated recomb",1.93,1.93,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7210",null,"Inj, afstyla, 1 i.u.",1.44,1.44,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7307",null,"Etonogestrel implant system","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7314",null,"Inj., yutiq, 0.01 mg",523.78,523.78,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7328",null,"Gelsyn-3 injection 0.1 mg",0.75,0.75,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7500",null,"Azathioprine oral 50mg",14.62,14.62,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7509",null,"Methylprednisolone oral",0.27,0.27,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7512",null,"Prednisone ir or dr oral 1mg",0.01,0.01,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7610",null,"Albuterol comp con","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7613",null,"Albuterol non-comp unit",0.03,0.03,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7627",null,"Budesonide comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7640",null,"Formoterol comp unit","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J7659",null,"Isoproterenol non-comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7674",null,"Methacholine chloride, neb",0.83,0.83,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7999",null,"Compounded drug, noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J8501",null,"Oral aprepitant","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J8700",null,"Temozolomide",0.2,0.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J9000",null,"Doxorubicin hcl injection",2.46,2.46,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9023",null,"Injection, avelumab, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9042",null,"Brentuximab vedotin inj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9065",null,"Inj cladribine per 1 mg",18.88,18.88,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9120",null,"Dactinomycin injection",546.61,546.61,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9175",null,"Elliotts b solution per ml","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9178",null,"Inj, epirubicin hcl, 2 mg",1.3,1.3,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9208",null,"Ifosfamide injection",26.38,26.38,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9211",null,"Idarubicin hcl injection",44.38,44.38,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9218",null,"Leuprolide acetate injeciton",8.01,8.01,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9250",null,"Methotrexate sodium inj",0.25,0.25,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9272",null,"Inj, dostarlimab-gxly, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9294",null,"Inj pemetrexed, hospira 10mg",10.46,10.46,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9307",null,"Pralatrexate injection",351.95,351.95,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9316",null,"Pertuzu, trastuzu, 10 mg",68.44,68.44,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["J9349",null,"Inj., tafasitamab-cxix",13.15,13.15,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["J9353",null,"Inj. margetuximab-cmkb, 5 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9360",null,"Vinblastine sulfate inj",3.99,3.99,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["K0002","NU","Stnd hemi (low seat) whlchr",725.11800000000005,725.11800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0008",null,"Cstm manual wheelchair/base","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["K0011","NU","Stnd wt pwr whlchr w control",6948.8520000000008,6948.8520000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0017","RR","Detach adjust armrest base",5.7527999999999997,5.7527999999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0037","NU","Hi mount flip-up footrest ea",54.131399999999999,54.131399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0043","NU","Ftrst lowr exten tube rep ea",22.633800000000001,22.633800000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0044","RR","Ftrst upr hanger brac rep ea",1.9583999999999999,1.9583999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0050","NU","Ratchet assembly replacement",37.525799999999997,37.525799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0070","NU","Rr whl compl pne tire rep ea",255.55299999999997,255.55299999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0455","NU","Pump uninterrupted infusion",3592.7460000000001,3592.7460000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0604","NU","Repl batt lithium 3.6 v",8.1498000000000008,8.1498000000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0739",null,"Repair/svc dme non-oxygen eq",29.101800000000001,29.101800000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0801","NU","Pov group 1 hd 301-450 lbs",2186.1354000000001,2186.1354000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0816","NU","Pwc gp 1 std cap chair",4714.848,4714.848,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0820","RR","Pwc gp 2 std port seat/back",396.99419999999998,396.99419999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0824","NU","Pwc gp 2 hd seat/back",6968.9460000000008,6968.9460000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0830","NU","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]
["K0836","RR","Pwc gp2 std sing pow opt cap",587.11200000000008,587.11200000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0842","RR","Pwc gp2 std mult pow opt cap",615.37619999999993,615.37619999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0852","RR","Pwc gp 3 vhd seat/back",1242.0642,1242.0642,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0856","NU","Pwc gp3 std sing pow opt s/b",9947.3459999999995,9947.3459999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0862","NU","Pwc gp3 hd mult pow opt s/b",12341.898000000001,12341.898000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0863","RR","Pwc gp3 vhd mult pow opt s/b",1763.2026000000001,1763.2026000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0877","NU","Pwc gp4 std 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]
["K0884","RR","Pwc gp4 std mult 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]
["K0898","NU","Power wheelchair noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K1004","RR","Lo freq us diathermy device","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1019",null,"Monthly supp use with k1018","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1026",null,"Mech allergen parti barrier","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L0130",null,"Flex thermoplastic collar mo",257.50540000000001,257.50540000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L0180",null,"Cer post col occ/man sup adj",550.63479999999993,550.63479999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0220",null,"Thor rib belt custom fabrica",172.3494,172.3494,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0467",null,"Tlso r fram soft pre ots",482.815,482.815,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0484",null,"Tlso rigid plastic cust fab",2324.8686000000002,2324.8686000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L0627",null,"Lo sag ri an/pos pnl pre cst",561.34640000000002,561.34640000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0639",null,"Lso s/c shell/panel prefab",1534.8453999999999,1534.8453999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0650",null,"Lso sc r ant/pos pnl pre ots",1299.5318,1299.5318,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0976",null,"Lso full corset",256.10239999999999,256.10239999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1001",null,"Ctlso infant immobilizer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L1020",null,"Kyphosis pad",133.4924,133.4924,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1120",null,"Covers for upright each",64.306200000000004,64.306200000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1260",null,"Anterior thoracic derotation",104.83460000000001,104.83460000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1650",null,"Ho abduction hip adjustable",302.88940000000002,302.88940000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1810",null,"Ko elastic with joints",149.14500000000001,149.14500000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1834",null,"Ko w/0 joint rigid molded to",1015.5158,1015.5158,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1860",null,"Ko supracondylar socket mold",1716.3081999999999,1716.3081999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1920",null,"Afo sing upright w/ adjust s",586.19780000000003,586.19780000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1940",null,"Afo molded to patient plasti",695.0218000000001,695.0218000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2010",null,"Kafo sng solid stirrup w/o j",1597.1019999999999,1597.1019999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2038",null,"Kafo w/o joint multi-axis an",2176.0896000000002,2176.0896000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2126",null,"Kafo fem fx cast thermoplas",1566.5287999999998,1566.5287999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2184",null,"Limited motion knee joint",162.05260000000001,162.05260000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2260",null,"Reinforced solid stirrup",262.23899999999998,262.23899999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2360",null,"Extended steel shank",90.243399999999994,90.243399999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2395",null,"Offset knee joint heavy duty",204.69159999999999,204.69159999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2415",null,"Knee joint cam lock each joi",165.85899999999998,165.85899999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2570",null,"Hip clevis type 2 posit jnt",641.89080000000001,641.89080000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2627",null,"Plastic mold recipro hip & c",2242.665,2242.665,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2780",null,"Non-corrosive finish",118.0472,118.0472,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2840",null,"Tibial length sock fx or equ",57.157000000000004,57.157000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3040",null,"Ft arch suprt premold longit",64.257400000000004,64.257400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3202",null,"Oxford w/ supinat/pronator c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L3211",null,"Surgical boot each junior","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L3214",null,"Benesch boot pair junior","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L3252",null,"Shoe molded plastazote cust",411.83190000000002,411.83190000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3300",null,"Sho lift taper to metatarsal",71.199200000000005,71.199200000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3400",null,"Shoe metatarsal bar wedge ro",55.595399999999998,55.595399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3460",null,"Shoe heel new rubber standar",46.847999999999999,46.847999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3570",null,"O shoe add instep extension",116.41240000000001,116.41240000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3670",null,"So acro/clav can web pre ots",150.47479999999999,150.47479999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3710",null,"Eo elas w/metal jnts pre ots",158.24620000000002,158.24620000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3740",null,"Cuffs adj lock w/ active con",1373.5736000000002,1373.5736000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3905",null,"Who w/nontorsion jnt(s) cf",1232.4928,1232.4928,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3912",null,"Hfo flexion glove pre ots",161.86959999999999,161.86959999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3929",null,"Hfo nontorsion jnts pre cst",121.24359999999999,121.24359999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3961",null,"Sewho cap design w/o jnts cf",2088.0178000000001,2088.0178000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L4002",null,"Replace strap, any orthosis",36.853200000000001,36.853200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L4070",null,"Replace prox & dist upright",435.78399999999999,435.78399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4210",null,"Orth dev repair/repl minor p",52.191299999999998,52.191299999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4361",null,"Pneuma/vac walk boot pre ots",482.97359999999998,482.97359999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L5105",null,"Plast socket jts/thgh lacer",5721.1976000000004,5721.1976000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5200",null,"Kne sing axis fric shin sach",5909.9957999999997,5909.9957999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5400",null,"Postop dress & 1 cast chg bk",1940.2298000000001,1940.2298000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5505",null,"Init ak ischal plstr direct",2523.5027,2523.5027,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5600",null,"Hip disart sach laminat mold",8255.1778000000013,8255.1778000000013,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5618",null,"Test socket symes",453.23759999999999,453.23759999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5637",null,"Below knee total contact",431.93970000000002,431.93970000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5640",null,"Knee disarticulat leather so",1214.2343000000001,1214.2343000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5658",null,"Socket insert above knee",703.36410000000001,703.36410000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5666",null,"Below knee cuff suspension",103.0478,103.0478,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5682",null,"Bk thigh lacer glut/ischia m",917.32099999999991,917.32099999999991,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5692",null,"Ak pelvic control belt light",226.26320000000001,226.26320000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5705",null,"Custom shape cover ak",1452.4863,1452.4863,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5716",null,"Knee-shin exo mech stance ph",1057.4401,1057.4401,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5810",null,"Endoskel knee-shin mnl lock",806.62779999999998,806.62779999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5814",null,"Endo knee-shin hydral swg ph",5289.7024000000001,5289.7024000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5859",null,"Knee-shin pro flex/ext cont",21899.651399999999,21899.651399999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5925",null,"Above knee manual lock",632.77750000000003,632.77750000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5971",null,"Sach foot, replacement",355.87940000000003,355.87940000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5979",null,"Multi-axial ankle/ft prosth",4373.2577000000001,4373.2577000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6010",null,"Part hand little/ring",2860.3575000000001,2860.3575000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6120",null,"Elbow mold doub splt soc ste",4351.5280000000002,4351.5280000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6382",null,"Postop dsg cast chg elb dis/",2335.6062000000002,2335.6062000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6388",null,"Postop applicat rigid dsg on",736.10469999999998,736.10469999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6615",null,"Disconnect locking wrist uni",310.07050000000004,310.07050000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6621",null,"Flex/ext wrist w/wo friction",3257.8167000000003,3257.8167000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6647",null,"Shoulder lock actuator",739.54640000000006,739.54640000000006,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6655",null,"Standard control cable extra",145.3134,145.3134,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6687",null,"Frame typ socket bel elbow/w",836.86650000000009,836.86650000000009,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6694",null,"Elbow socket ins use w/lock",1039.2791,1039.2791,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6712",null,"Ped term dev, hook, vol clos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L6715",null,"Term device, multi art digit",4496.7143999999998,4496.7143999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6915",null,"Hand restoration replacmnt g",1053.4903999999999,1053.4903999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6930",null,"Below elbow switch control",12249.086500000001,12249.086500000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L7180",null,"Electronic elbow sequential",53156.116699999999,53156.116699999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L7186",null,"Electron elbow child switch","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X","Y",null,2,9]
["L7402",null,"Add ue prost s/d ultlite mat",527.77390000000003,527.77390000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L7600",null,"Prosthetic donning sleeve",121.81740000000001,121.81740000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8032",null,"Reusable nipple prosthesis",57.950100000000006,57.950100000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["L8043",null,"Upper facial prosthesis",5401.6782999999996,5401.6782999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8410",null,"Sheath above knee",38.392099999999999,38.392099999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8420",null,"Prosthetic sock multi ply bk",29.095700000000001,29.095700000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8511",null,"Indwelling trach insert",103.59389999999999,103.59389999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8514",null,"Repl trach puncture dilator",134.28979999999999,134.28979999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8613",null,"Ossicular implant",436.7022,436.7022,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8621",null,"Repl zinc air battery",0.8889999999999999,0.8889999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["L8658",null,"Interphalangeal joint spacer",590.41030000000001,590.41030000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8682",null,"Implt neurostim radiofq rec",8820.8358000000007,8820.8358000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["L8696",null,"Ext antenna phren nerve stim","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L8699",null,"Prosthetic implant nos",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,9]
["M0240",null,"CASIRI AND IMDEV REPEAT",472.77,472.77,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["M0244",null,"Bamlan and estesv infus",787.95,787.95,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["M1006",null,"Dz not ases, no rsn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1013",null,"Dc eoc doc med rec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1035",null,"Adt pd out mat pr 180 dys tx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1043",null,"Fs no odi 9-15mo","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1060",null,"Pt died in pp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1069",null,"Pt scr ft fall rsk","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1120",null,"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]
["M1123",null,"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]
["M1130",null,"Oc ni pt self dc 1-2 vis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1148",null,"Pt self dschg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1160",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1167",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1179",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1182",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1198",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1201",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1208",null,"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["P9011",null,"Blood split unit","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9032",null,"Platelets, irradiated","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9039",null,"Rbc deglycerolized","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9053",null,"Plt, pher, l/r cmv-neg, irr","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9056",null,"Blood, l/r, irradiated","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q0035",26,"Cardiokymography","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["Q0084",null,"Chemotherapy by infusion",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["Q0114",null,"Fern test",13.8308,13.8308,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["Q0173",null,"Trimethobenzamide hcl 250mg",1.08,1.08,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["Q0247",null,"Sotrovimab",2465.8200000000002,2465.8200000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["Q0482",null,"Microprcsr cu combo vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["Q0494",null,"Emr hd pmp elec/combo, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0501",null,"Shwr cov elec/combo vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0514",null,"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]
["Q1005",null,"Ntiol category 5","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q2036",null,"Flulaval vacc, 3 yrs & >, im","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q2056",null,"Ciltacabtagene car-pos t","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4007",null,"Cast sup long arm ped plster","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["Q4014",null,"Cast sup gauntlet fiberglass",32.211599999999997,32.211599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4026",null,"Cast sup hip spica fiberglas",143.0754,143.0754,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4033",null,"Cast sup lng leg cylinder pl",32.7012,32.7012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4045",null,"Cast sup sht leg splnt plstr",14.076000000000001,14.076000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4048",null,"Cast sup sht leg splnt ped f","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["Q4100",null,"Skin substitute, nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["Q4113",null,"Graftjacket xpress","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q4122",null,"Dermacell, awm, porous sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4136",null,"Ezderm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4149",null,"Excellagen, 0.1 cc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4156",null,"Neox 100 or clarix 100","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4168",null,"Amnioband, 1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4171",null,"Interfyl, 1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4179",null,"Flowerderm, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4212",null,"Allogen, per cc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4219",null,"Surgigraft dual per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4233",null,"Surfactor /nudyn per 0.5 cc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4247",null,"Amniotext patch, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4254",null,"Novafix dl per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4266",null,"Neostim per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4269",null,"Surgraft xt per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q5005",null,"Hospice, inpatient hospital","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["Q5113",null,"Inj herzuma 10 mg",29.53,29.53,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["Q5120",null,"Inj pegfilgrastim-bmez 0.5mg",80.06,80.06,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2]
["Q9002",null,"Va chaplain counsel individu","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q9960",null,"Hocm 200-249mg/ml iodine,1ml",0.2,0.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["Q9967",null,"Locm 300-399mg/ml iodine,1ml",0.17,0.17,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["R0076",null,"Transport portable ekg",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["R0360",null,"Retraining board","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["R0392",null,"Retraining child care licensd 7-9 hrs ea","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S0032",null,"Injection, nafcillin sodium","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0078",null,"Injection, fosphenytoin sodi","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0117",null,"Tretinoin topical 5 g","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0145",null,"Peg interferon alfa-2a/180",1021.49,1021.49,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["S0166",null,"Inj olanzapine 2.5mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0183",null,"Prochlorperazine 5 mg",0.28999999999999998,0.28999999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["S0199",null,"Med abortion inc all ex drug","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S0208",null,"Paramed intrcept nonvol","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0272",null,"Home episodic case 30 days","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0315",null,"Disease management program","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0500",null,"Dispos cont lens","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0515",null,"Scleral lens liquid bandage","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0613",null,"Ann breast exam","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S1016",null,"Non-pvc intravenous administ","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S1040",null,"Cranial remolding orthosis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2054",null,"Transplantation of multivisc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2095",null,"Transcath emboliz microspher","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2118",null,"Total hip resurfacing","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2225",null,"Myringotomy laser-assist","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2300",null,"Arthroscopy, shoulder, surgi","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2404",null,"Fetal surg myelomeningo","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3650",null,"Saliva test, hormone level;","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3841",null,"Gene test retinoblastoma","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3845",null,"Gene test alpha-thalassemia","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3904",null,"Masters two step","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4017",null,"Ivf canc a stim case rate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4035",null,"Stimulated iui case rate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4991",null,"Nicotine patch nonlegend","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5101",null,"Adult day care per half day","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5126",null,"Attendant care service /diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5145",null,"Child fostercare th per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5151",null,"Unskilled respitecare /diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5517",null,"Hit declotting kit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5521",null,"Hit midline cath insert kit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5571",null,"Insulin dispos pen 3 ml","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8055",null,"Us guidance fetal reduct","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8130",null,"Interferential stim 2 chan","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8265",null,"Haberman feeder","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8270",null,"Enuresis alarm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8301",null,"Infect control supplies nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["S8415",null,"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,"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,"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,"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,"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,"Ready gradient sleeve","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8425",null,"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,"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,"Ready gradient glove","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8428",null,"Ready gradient gauntlet","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8429",null,"Gradient pressure wrap","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8430",null,"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,"Compression bandage","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8450",null,"Splint digit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8451",null,"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,"Splint elbow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8460",null,"Camisole post-mast","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8490",null,"100 insulin syringes","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8930",null,"Auricular electrostimulation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8940",null,"Hippotherapy per session","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8948",null,"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,"Complex lymphedema therapy,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8990",null,"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,"Resuscitation bag","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9001",null,"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,"Ultrafiltration monitor","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9024",null,"Paranasal sinus ultrasound","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9025",null,"Omnicardiogram/cardiointegra","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9034",null,"Eswl for gallstones","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9055",null,"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,"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,"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,"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,"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,"Vertebral axial decompressio","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9097",null,"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,"Home phototherapy visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9110",null,"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,"Back school visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9122",null,"Home health aide or certifie",33.712913520000001,33.712913520000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9123",null,"Nursing care in home rn",67.788700581887994,67.788700581887994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9124",null,"Nursing care, in the home; b",48.965861520575999,48.965861520575999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9125",null,"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,"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,"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,"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,"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,"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,"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9141",null,"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9145",null,"Insulin pump initiation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9150",null,"Evaluation by ocularist","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9152",null,"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,"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,"Home mgmt pprom","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9211",null,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"Ht hemodialysis diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9336",null,"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,"Hit immunotherapy diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9339",null,"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,"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,"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,"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,"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,"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,"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,"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,"Hit sympathomim diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9349",null,"Hit tocolysis diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9351",null,"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,"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,"Hit chelation diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9357",null,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"Lamaze class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9437",null,"Childbirth refresher class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9438",null,"Cesarean birth class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9439",null,"Vbac class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9441",null,"Asthma education","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9442",null,"Birthing class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9443",null,"Lactation class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9444",null,"Parenting class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9445",null,"Pt education noc individ",45.545533203455996,45.545533203455996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9446",null,"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,"Infant safety class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9449",null,"Weight mgmt class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9451",null,"Exercise class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9452",null,"Nutrition class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9453",null,"Smoking cessation class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9454",null,"Stress mgmt class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9455",null,"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9460",null,"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9465",null,"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9470",null,"Nutritional counseling, diet","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9472",null,"Cardiac rehabilitation progr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9473",null,"Pulmonary rehabilitation pro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9474",null,"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,"Ambulatory setting substance","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9476",null,"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,"Intensive outpatient psychia","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,17]
["S9482",null,"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,"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,"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,"Hit corticosteroid/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9494",null,"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,"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,"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,"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,"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,"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,"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,"Venipuncture home/snf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9537",null,"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,"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,"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,"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,"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,"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,"Ht inj palivizumab diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9563",null,"Ht inj immuno diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9590",null,"Ht irrigation diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9810",null,"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,"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,"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,"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,"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,"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,"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,"Lodging per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9977",null,"Meals per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9981",null,"Med record copy admin",29.492056747296004,29.492056747296004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9982",null,"Med record copy per page",0.58476580905600006,0.58476580905600006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9986",null,"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,"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,"Services outside us","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9990",null,"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,"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,"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,"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,"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,"Sales tax","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1000",null,"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,"Nursing assessment/evaluatn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1002",null,"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,"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,"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,"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,"Family/couple counseling","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1007",null,"Treatment plan development","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1009",null,"Child sitting services","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1010",null,"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,"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,"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,"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,"Clinic service","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["T1016",null,"Case management","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1017",null,"Targeted case management","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1018",null,"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,"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,"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,"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,"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,"Program intake assessment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1024",null,"Team evaluation & management","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1025",null,"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,"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,"Family training & counseling","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1028",null,"Home environment assessment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1029",null,"Dwelling lead investigation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1030",null,"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,"Lpn home care per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1032",null,"Sv doula brth wrk per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1033",null,"Sv doula brth wrk per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1040",null,"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,"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,"Medication admin visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1503",null,"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,"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,"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,"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,"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,"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,"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,"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,"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,"Pasrr level i","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2011",null,"Pasrr level ii","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2012",null,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"Waiver service, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2026",null,"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,"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,"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,"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,"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,"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,"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,"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,"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,"Utility services waiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2036",null,"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,"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,"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,"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,"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,"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,"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,"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,"Hospice respite care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2045",null,"Hospice general care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2046",null,"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,"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,"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,"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,"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,"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,"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,"Adult size brief/diaper sm",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4522",null,"Adult size brief/diaper med",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4523",null,"Adult size brief/diaper lg",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4524",null,"Adult size brief/diaper xl",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4525",null,"Adult size pull-on sm",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4526",null,"Adult size pull-on med",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4527",null,"Adult size pull-on lg",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4528",null,"Adult size pull-on xl",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4529",null,"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,"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,"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,"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,"Youth size brief/diaper",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4534",null,"Youth size pull-on",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4535",null,"Disposable liner/shield/pad",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4536",null,"Reusable pull-on any size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4537",null,"Reusable underpad bed size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4538",null,"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,"Reuse diaper/brief any size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4540",null,"Reusable underpad chair size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4541",null,"Large disposable underpad",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4542",null,"Small disposable underpad",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4543",null,"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,"Adlt disp und/pull on abv xl",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4545",null,"Incon disposable penile wrap",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T5001",null,"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,"Supply, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["U0001",null,"2019-ncov diagnostic p",51.006399999999999,51.006399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["U0002",null,"Covid-19 lab test non-cdc",72.860200000000006,72.860200000000006,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["V0028",null,"Travel, vocational services, claimant","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2]
["V2020",null,"Vision svcs frames purchases",82.62,82.62,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2025",null,"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,"Lens spher single plano 4.00",52.193400000000004,52.193400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2101",null,"Single visn sphere 4.12-7.00",53.672399999999996,53.672399999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2102",null,"Singl visn sphere 7.12-20.00",67.656599999999997,67.656599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2103",null,"Spherocylindr 4.00d/12-2.00d",49.572000000000003,49.572000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2104",null,"Spherocylindr 4.00d/2.12-4d",51.020400000000002,51.020400000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2105",null,"Spherocylinder 4.00d/4.25-6d",57.558599999999998,57.558599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2106",null,"Spherocylinder 4.00d/>6.00d",61.750799999999998,61.750799999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2107",null,"Spherocylinder 4.25d/12-2d",53.519399999999997,53.519399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2108",null,"Spherocylinder 4.25d/2.12-4d",52.224000000000004,52.224000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2109",null,"Spherocylinder 4.25d/4.25-6d",64.106999999999999,64.106999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2110",null,"Spherocylinder 4.25d/over 6d",57.007800000000003,57.007800000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2111",null,"Spherocylindr 7.25d/.25-2.25",59.425199999999997,59.425199999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2112",null,"Spherocylindr 7.25d/2.25-4d",65.840999999999994,65.840999999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2113",null,"Spherocylindr 7.25d/4.25-6d",77.764799999999994,77.764799999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2114",null,"Spherocylinder over 12.00d",84.731399999999994,84.731399999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2115",null,"Lens lenticular bifocal",102.32639999999999,102.32639999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2118",null,"Lens aniseikonic single",96.573600000000013,96.573600000000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2121",null,"Lenticular lens, single",108.0894,108.0894,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2199",null,"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,"Lens spher bifoc plano 4.00d",74.266199999999998,74.266199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2201",null,"Lens sphere bifocal 4.12-7.0",74.561999999999998,74.561999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2202",null,"Lens sphere bifocal 7.12-20.",81.997799999999998,81.997799999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2203",null,"Lens sphcyl bifocal 4.00d/.1",72.868799999999993,72.868799999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2204",null,"Lens sphcy bifocal 4.00d/2.1",73.225800000000007,73.225800000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2205",null,"Lens sphcy bifocal 4.00d/4.2",75.775800000000004,75.775800000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2206",null,"Lens sphcy bifocal 4.00d/ove",76.367400000000004,76.367400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2207",null,"Lens sphcy bifocal 4.25-7d/.",71.226600000000005,71.226600000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2208",null,"Lens sphcy bifocal 4.25-7/2.",69.880200000000002,69.880200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2209",null,"Lens sphcy bifocal 4.25-7/4.",80.661599999999993,80.661599999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2210",null,"Lens sphcy bifocal 4.25-7/ov",91.473600000000005,91.473600000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2211",null,"Lens sphcy bifo 7.25-12/.25-",99.878399999999999,99.878399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2212",null,"Lens sphcyl bifo 7.25-12/2.2",100.6332,100.6332,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2213",null,"Lens sphcyl bifo 7.25-12/4.2",96.910200000000003,96.910200000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2214",null,"Lens sphcyl bifocal over 12.",101.745,101.745,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2215",null,"Lens lenticular bifocal",122.2266,122.2266,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2218",null,"Lens aniseikonic bifocal",127.94880000000001,127.94880000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2219",null,"Lens bifocal seg width over",51.877200000000002,51.877200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2220",null,"Lens bifocal add over 3.25d",42.075000000000003,42.075000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2221",null,"Lenticular lens, bifocal",112.8732,112.8732,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2299",null,"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,"Lens sphere trifocal 4.00d",87.964799999999997,87.964799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2301",null,"Lens sphere trifocal 4.12-7.",92.432400000000001,92.432400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2302",null,"Lens sphere trifocal 7.12-20",95.553600000000003,95.553600000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2303",null,"Lens sphcy trifocal 4.0/.12-",87.414000000000001,87.414000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2304",null,"Lens sphcy trifocal 4.0/2.25",80.784000000000006,80.784000000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2305",null,"Lens sphcy trifocal 4.0/4.25",91.034999999999997,91.034999999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2306",null,"Lens sphcyl trifocal 4.00/>6",93.421800000000005,93.421800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2307",null,"Lens sphcy trifocal 4.25-7/.",94.992599999999996,94.992599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2308",null,"Lens sphc trifocal 4.25-7/2.",105.3456,105.3456,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2309",null,"Lens sphc trifocal 4.25-7/4.",108.9156,108.9156,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2310",null,"Lens sphc trifocal 4.25-7/>6",103.9992,103.9992,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2311",null,"Lens sphc trifo 7.25-12/.25-",103.8156,103.8156,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2312",null,"Lens sphc trifo 7.25-12/2.25",106.9164,106.9164,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2313",null,"Lens sphc trifo 7.25-12/4.25",119.92139999999999,119.92139999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2314",null,"Lens sphcyl trifocal over 12",125.23560000000001,125.23560000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2315",null,"Lens lenticular trifocal",141.75960000000001,141.75960000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2318",null,"Lens aniseikonic trifocal",170.9316,170.9316,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2319",null,"Lens trifocal seg width > 28",57.8748,57.8748,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2320",null,"Lens trifocal add over 3.25d",69.084600000000009,69.084600000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2321",null,"Lenticular lens, trifocal",137.0472,137.0472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2399",null,"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,"Lens variab asphericity sing",123.62400000000001,123.62400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2430",null,"Lens variable asphericity bi",129.09120000000001,129.09120000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2499",null,"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,"Contact lens pmma spherical",126.276,126.276,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2501",null,"Cntct lens pmma-toric/prism",144.2688,144.2688,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2502",null,"Contact lens pmma bifocal",177.72480000000002,177.72480000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2503",null,"Cntct lens pmma color vision",174.6036,174.6036,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2510",null,"Cntct gas permeable sphericl",161.8638,161.8638,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2511",null,"Cntct toric prism ballast",185.77260000000001,185.77260000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2512",null,"Cntct lens gas permbl bifocl",219.50399999999999,219.50399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2513",null,"Contact lens extended wear",201.22560000000001,201.22560000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2520",null,"Contact lens hydrophilic",136.28220000000002,136.28220000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2521",null,"Cntct lens hydrophilic toric",211.57860000000002,211.57860000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2522",null,"Cntct lens hydrophil bifocl",205.9074,205.9074,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2523",null,"Cntct lens hydrophil extend",179.18339999999998,179.18339999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2524",null,"Cntct lens hydrophil photoch",157.44720000000001,157.44720000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2525",null,"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,"Contact lens gas impermeable",259.88580000000002,259.88580000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2531",null,"Contact lens gas permeable",619.39499999999998,619.39499999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2599",null,"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,"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,"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,"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,"Plastic eye prosth custom","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2624",null,"Polishing artifical eye","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2625",null,"Enlargemnt of eye prosthesis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2626",null,"Reduction of eye prosthesis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2627",null,"Scleral cover shell","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2628",null,"Fabrication & fitting","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2629",null,"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,"Anter chamber intraocul lens",138.6996,138.6996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2631",null,"Iris support intraoclr lens",138.6996,138.6996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2632",null,"Post chmbr intraocular lens",138.6996,138.6996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2700",null,"Balance lens",51.050999999999995,51.050999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2702",null,"Deluxe lens feature","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2710",null,"Glass/plastic slab off prism",74.715000000000003,74.715000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2715",null,"Prism lens/es",16.656599999999997,16.656599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2718",null,"Fresnell prism press-on lens",33.272399999999998,33.272399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2730",null,"Special base curve",24.5718,24.5718,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2744",null,"Tint photochromatic lens/es",21.164999999999999,21.164999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2745",null,"Tint, any color/solid/grad",14.310599999999999,14.310599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2750",null,"Anti-reflective coating",22.236000000000001,22.236000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2755",null,"Uv lens/es",20.726400000000002,20.726400000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2756",null,"Eye glass case","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2760",null,"Scratch resistant coating",18.666,18.666,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2761",null,"Mirror coating","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2762",null,"Polarization, any lens",68.1768,68.1768,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2770",null,"Occluder lens/es",22.95,22.95,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2780",null,"Oversize lens/es",14.596200000000001,14.596200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2781",null,"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,"Lens, 1.54-1.65 p/1.60-1.79g",73.644000000000005,73.644000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2783",null,"Lens, >= 1.66 p/>=1.80 g",83.007599999999996,83.007599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2784",null,"Lens polycarb or equal",53.988599999999998,53.988599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2785",null,"Corneal tissue processing","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2786",null,"Occupational multifocal lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2787",null,"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,"Presbyopia-correct function","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V2790",null,"Amniotic membrane","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2797",null,"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,"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,"Hearing screening",91.717702551228101,91.717702551228101,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5010",null,"Assessment for hearing aid",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5]
["V5011",null,"Hearing aid fitting/checking",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5]
["V5014",null,"Hearing aid repair/modifying",61.14888672976101,61.14888672976101,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,5]
["V5020",null,"Conformity evaluation",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5]
["V5030",null,"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,"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,"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,"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,"Glasses air conduction","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5080",null,"Glasses bone conduction","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5090",null,"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,"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,"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,"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,"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,"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,"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,"Glasses binaural hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5160",null,"Dispensing fee binaural",1736.5923668473672,1736.5923668473672,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5171",null,"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,"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,"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,"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,"Disp fee contralateral monau",1040.870429738321,1040.870429738321,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5211",null,"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,"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,"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,"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,"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,"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,"Hearing aid binaural glasses","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5240",null,"Disp fee contralateral binau",1040.870429738321,1040.870429738321,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5241",null,"Dispensing fee, monaural",868.2961834236836,868.2961834236836,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5242",null,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"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,"Battery for hearing device",1.0692332485417442,1.0692332485417442,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,5]
["V5267",null,"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,"Ald telephone amplifier","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5269",null,"Alerting device, any type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5270",null,"Ald, tv amplifier, any type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5271",null,"Ald, tv caption decoder","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5272",null,"Tdd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5273",null,"Ald for cochlear implant","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5274",null,"Ald unspecified","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5275",null,"Ear impression","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5281",null,"Ald fm/dm system, monaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5282",null,"Ald fm/dm system binaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5283",null,"Ald neck, loop ind receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5284",null,"Ald fm/dm ear level receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5285",null,"Ald fm/dm aud input receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5286",null,"Ald blu tooth fm/dm receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5287",null,"Ald fm/dm receiver, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5288",null,"Ald fm/dm transmitter ald","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5289",null,"Ald fm/dm adapt/boot couplin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5290",null,"Ald transmitter microphone","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5298",null,"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,"Hearing service","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,5]
["V5336",null,"Repair communication device","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V5362",null,"Speech screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V5363",null,"Language screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V5364",null,"Dysphagia screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]

{"sheet":"Table","index":5,"n_rows":20261,"n_cols":23,"rows_kept":4500,"cut":true,"hidden":true,"merged":[],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
[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"]
["01953",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",57.45,57.45,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,4]
["01996",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",76.153199999999998,76.153199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,4]
["01999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,4]
[10004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",92.287000000000006,75.615799999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.4496,131.58339999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",109.5536,89.31,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10007,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",560.86680000000001,157.78100000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",269.12079999999997,91.691599999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10009,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",825.81979999999999,194.10039999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",450.12239999999997,126.2248,"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",1236.0504000000001,239.9462,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",218.51179999999999,93.477800000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",234.58759999999998,194.69579999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10061,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",394.15480000000002,336.40100000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.70159999999993,192.3142,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",647.19979999999998,310.20339999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",284.00579999999997,194.10039999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",491.80039999999997,334.01940000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",315.56200000000001,215.53479999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",242.32780000000002,176.8338,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",490.01420000000002,325.08839999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",107.76739999999999,48.227400000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",50.608999999999995,26.197600000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1000.8673999999999,1000.8673999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.9166,1356.9166,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1231.2872,1231.2872,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.10619999999994,478.10619999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",843.68179999999995,498.94520000000006,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R",null,null,2,29]
[11011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",922.87,528.7152000000001,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1205.0895999999998,743.05920000000003,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11042,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",241.73239999999998,107.76739999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11043,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",427.49719999999996,274.4794,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.4162,400.70420000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",73.234200000000001,44.655000000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",132.17880000000002,96.454800000000006,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",217.91640000000001,170.87980000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",135.75119999999998,27.983799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11056,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",155.9948,39.296399999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",169.68899999999999,50.608999999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",191.71880000000002,67.875599999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",94.668599999999998,38.701000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11104,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",237.56460000000001,84.54679999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",111.33980000000001,45.845799999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",294.12760000000003,101.21799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",134.56039999999999,55.372199999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",170.87980000000002,141.70519999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",33.342400000000005,29.77,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",192.3142,61.3262,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",230.41980000000001,92.287000000000006,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",258.99899999999997,107.76739999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11303,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",286.38739999999996,127.41560000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",200.05439999999999,66.68480000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",232.20599999999999,88.119199999999992,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",261.976,112.53059999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",275.07479999999998,125.03400000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",220.298,82.165199999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11311,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",257.8082,113.12599999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",294.12760000000003,135.1558,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",339.97339999999997,172.07060000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",241.73239999999998,155.39939999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11401,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",293.53219999999999,195.29119999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11402,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",322.1114,212.55779999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11403,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",369.14800000000002,273.88399999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11404,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",418.56619999999998,300.67699999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",588.85059999999999,450.12239999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",239.9462,151.23159999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11421,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",300.08159999999998,201.24519999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",335.80559999999997,249.47260000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11423,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",381.65140000000002,286.38739999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11424,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",438.21440000000001,326.2792,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",608.49880000000007,488.82340000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",270.90699999999998,197.6728,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11441,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",326.2792,245.3048,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",362.00319999999999,270.3116,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11443,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",425.11559999999997,327.46999999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11444,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",525.14279999999997,411.42140000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",705.54899999999998,573.96559999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",810.33939999999996,478.70159999999993,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11451,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",987.17319999999984,604.92639999999994,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",785.33259999999996,454.29019999999997,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11463,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1001.4628,609.0942,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",857.37599999999998,525.73820000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11471,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1011.5845999999999,637.67340000000002,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[11600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",370.93420000000003,223.27500000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",428.0926,270.90699999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11602,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",457.86260000000004,294.12760000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11603,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",520.37959999999998,351.286,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",578.72879999999998,385.81920000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",826.41520000000003,568.60700000000008,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",372.72039999999998,224.4658,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11621,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",430.4742,272.09780000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11622,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",472.74760000000003,308.41719999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11623,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",550.745,380.4606,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11624,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",625.7654,430.4742,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",751.39479999999992,525.14279999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11640,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",381.65140000000002,231.61060000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",444.16840000000002,283.41039999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11642,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",500.13600000000002,330.447,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11643,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",585.27819999999997,411.42140000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11644,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",719.83859999999993,509.06700000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11646,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",930.01479999999992,701.38119999999992,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11719,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.197600000000001,13.098800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.730800000000002,25.6022,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11721,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.165199999999999,42.273399999999995,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",215.53479999999999,96.454800000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11732,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",61.921599999999998,30.365400000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",107.76739999999999,58.944600000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",297.7,183.9786,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11755,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",229.22900000000001,108.36280000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",350.69059999999996,201.84059999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11762,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",536.45539999999994,339.97339999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11765,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",311.39420000000001,169.68899999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",667.4434,335.80559999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11771,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1168.1748,817.48419999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11772,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1437.2955999999999,1059.2166,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",106.5766,54.181400000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",129.7972,82.165199999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",359.6216,197.07740000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11921,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",417.37539999999996,236.9692,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",113.72139999999999,52.395200000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11950,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",151.23159999999999,94.0732,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11951,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",199.459,130.988,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11952,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",266.1438,183.38319999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11954,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",292.93680000000001,200.6498,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11960,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1870.1514,1870.1514,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11970,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1027.6604,1027.6604,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11971,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1011.5845999999999,1011.5845999999999,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",185.1694,111.33980000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11982,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",206.60380000000001,131.58339999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11983,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",260.18979999999999,184.57400000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",175.643,79.783600000000007,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",211.36699999999999,104.19499999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",244.70940000000002,129.20179999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",326.87459999999999,166.11660000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",378.67439999999999,204.8176,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12007,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",425.11559999999997,254.83120000000002,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[12011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",209.58080000000001,97.645599999999988,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",217.91640000000001,102.4088,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",264.95300000000003,130.988,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",317.9436,165.52119999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12016,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",404.27659999999997,224.4658,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12017,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",269.71620000000001,269.71620000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12018,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",304.24940000000004,304.24940000000004,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[12020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",561.46219999999994,342.9504,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12021,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",328.66079999999999,257.8082,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",497.15899999999999,277.45640000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12032,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",570.98860000000002,347.1182,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",626.36079999999993,373.31579999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",726.98340000000007,436.4282,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",802.5992,506.68539999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12037,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",896.67240000000004,588.25520000000006,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R",null,null,2,29]
[12041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",498.34979999999996,264.35760000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12042,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",581.11040000000003,356.04920000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",716.86159999999995,387.60539999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.61540000000002,499.54060000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",929.4194,573.37020000000007,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1016.3478,635.88720000000001,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[12051,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",534.07380000000001,309.01260000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",592.423,363.19399999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12053,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",684.1146,391.17779999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12054,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",721.02940000000001,396.53640000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",949.6629999999999,541.81399999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12056,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1083.6279999999999,698.99959999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1135.4277999999999,760.32579999999996,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[13100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",640.65039999999999,363.7894,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",746.03620000000001,450.12239999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",216.72560000000001,128.011,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",667.4434,422.73399999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",797.24059999999997,466.19819999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",235.7784,147.6592,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",726.98340000000007,437.61899999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13132,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",880.59659999999997,547.76799999999992,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13133,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",309.608,223.87039999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",790.69119999999998,503.11299999999994,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",926.44240000000002,606.11720000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13153,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",341.16419999999999,244.70940000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1442.0588,1442.0588,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1179.4874,920.48840000000007,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1497.4309999999998,1187.8229999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1305.1168,1035.9959999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14021,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1602.8168000000001,1291.4226000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1406.3348000000001,1137.2140000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1705.2256,1387.8773999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.8381999999999,1213.4251999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14061,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1839.1905999999999,1490.2862,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1999.9486000000002,1576.0237999999999,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[14302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",384.6284,384.6284,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[14350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1227.7148,1227.7148,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",638.86419999999998,391.77319999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",127.41560000000001,79.783600000000007,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",728.76959999999997,466.19819999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",211.36699999999999,158.37640000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",493.58659999999992,222.08420000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1105.0623999999998,848.44499999999994,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1601.626,1300.9490000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",345.92739999999998,198.26820000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1524.2240000000002,1289.0409999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",201.24519999999998,180.40619999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1466.4702,1244.9813999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",276.86099999999999,246.49559999999997,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1558.1618000000001,1252.1262000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",387.60539999999997,239.9462,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1338.4592,1092.559,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",175.643,160.1626,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1619.4879999999998,1382.5187999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",173.26140000000001,160.1626,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1281.8962000000001,1150.3127999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",210.17619999999999,191.71880000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",268.52539999999999,250.06800000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1460.5162,1327.742,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",281.62420000000003,263.16679999999997,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15157,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",314.37119999999999,286.9828,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1548.6354000000001,1222.9515999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",261.976,136.3466,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1427.1737999999998,1113.3979999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15221,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",242.32780000000002,122.6524,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1718.9198000000001,1453.3714,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15241,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",320.92059999999998,188.1464,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1846.9307999999999,1543.2768000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",381.05600000000004,244.11399999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",285.79199999999997,148.85,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",44.059599999999996,29.77,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",573.37020000000007,347.1182,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.01779999999999,79.188200000000009,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",294.12760000000003,166.11660000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15276,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",58.944600000000001,44.059599999999996,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15277,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",635.88720000000001,398.91800000000001,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[15278,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",176.23839999999998,98.836399999999998,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1675.4556,1327.1466,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15572,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1625.442,1342.0316,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15574,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1616.511,1337.8637999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1445.0357999999999,1183.0598,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",639.45960000000002,392.964,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",693.64099999999996,452.50399999999996,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.91859999999997,602.5447999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",865.11619999999994,632.91020000000003,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1010.3937999999999,741.27299999999991,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2665.0103999999997,1667.12,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15731,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2066.6334000000002,1817.7562,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15733,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1868.3652,1868.3652,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15734,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2700.7343999999998,2700.7343999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15736,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2208.3386,2208.3386,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15738,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2294.6716000000001,2294.6716000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1866.579,1533.155,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1681.4096,1681.4096,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4127.3127999999997,4127.3127999999997,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15757,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4105.2830000000004,4105.2830000000004,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15758,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4091.5888,4091.5888,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1565.902,1277.7284,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15769,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",875.83339999999998,875.83339999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[15770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1231.8826000000001,1231.8826000000001,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",698.99959999999999,459.05340000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15776,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",942.51819999999998,626.95619999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15777,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",382.84219999999999,382.84219999999999,"000",0,0,0,0,0,1,1,0,0,null,"R",null,null,2,29]
[15778,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",679.94679999999994,679.94679999999994,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[15780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1576.0237999999999,1215.8068000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15781,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1006.2259999999999,789.50040000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15782,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.98500000000001,679.94679999999994,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15783,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.32320000000004,651.96299999999997,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15786,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",431.06959999999998,244.70940000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[15787,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",55.967599999999997,29.77,"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",1074.1016,949.06759999999997,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15821,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1148.5265999999999,1010.9892,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",860.35299999999995,736.50979999999993,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15823,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1152.0990000000002,1013.3707999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15824,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1608.0177083667843,1608.0177083667843,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1382.618072268576,1382.618072268576,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15826,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1307.4701491463043,1307.4701491463043,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15828,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4478.4344653139533,4478.4344653139533,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15829,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2124.3872000000001,2124.3872000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[15832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1679.6233999999999,1679.6233999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[15833,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1602.2213999999999,1602.2213999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15834,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1630.2051999999999,1630.2051999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15835,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1696.8899999999999,1696.8899999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15836,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1458.1345999999999,1458.1345999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15837,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1604.0076000000001,1311.0708,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15838,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1191.3954000000001,1191.3954000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15839,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1643.8994,1347.3901999999998,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1845.74,1845.74,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3227.6633999999999,3227.6633999999999,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4875.1351999999997,4875.1351999999997,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15845,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1936.8362,1936.8362,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15847,null,{"$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]
[15851,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",102.4088,117.29379999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",81.569800000000001,81.569800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15853,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.4344,21.4344,"000",0,0,0,5,2,0,1,0,0,null,"R",null,null,2,29]
[15854,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",30.365400000000001,30.365400000000001,"000",0,0,0,5,2,0,1,0,0,null,"R",null,null,2,29]
[15860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",188.74179999999998,188.74179999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15876,null,{"$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",1171.1518000000001,1171.1518000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1462.3023999999998,1462.3023999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1278.9192,1278.9192,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1586.1456000000001,1586.1456000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15934,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1721.8968,1721.8968,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2110.6930000000002,2110.6930000000002,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15936,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1634.9684,1634.9684,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15937,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1896.3490000000002,1896.3490000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1287.2547999999999,1287.2547999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15941,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1711.7749999999999,1711.7749999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15944,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1711.1795999999999,1711.1795999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15945,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1865.3881999999999,1865.3881999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15946,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2929.3679999999999,2929.3679999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15950,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15951,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1649.258,1649.258,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R",null,null,2,29]
[15952,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1676.0509999999999,1676.0509999999999,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15953,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1846.3354000000002,1846.3354000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15956,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2113.67,2113.67,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15958,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2146.4169999999999,2146.4169999999999,"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",144.68219999999999,81.569800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",159.56720000000001,101.21799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",288.76899999999995,198.86359999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",363.19399999999996,235.7784,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",345.92739999999998,345.92739999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",145.87300000000002,145.87300000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[17000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",125.62939999999999,101.21799999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.503399999999999,3.5724,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",317.34820000000002,181.0016,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",638.26880000000006,505.49459999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",827.60599999999999,655.53539999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17108,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1167.5793999999999,957.40319999999986,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[17110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",214.93939999999998,124.43859999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",250.06800000000001,151.827,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",165.52119999999999,67.875599999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[17260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",186.9556,129.20179999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",278.05180000000001,158.37640000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",334.6148,201.24519999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17263,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",361.40780000000001,222.08420000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17264,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",387.01,236.37380000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17266,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",440.00059999999996,278.6472,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",280.43340000000001,173.85679999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",311.9896,191.71880000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",353.07219999999995,220.298,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",390.58239999999995,248.87719999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",456.07639999999998,304.24940000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17276,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",528.11979999999994,365.57559999999995,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",262.57139999999998,157.78100000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",336.40100000000001,214.93939999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",384.03300000000002,248.2818,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",451.90859999999998,308.41719999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",513.23479999999995,359.6216,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",653.74919999999997,484.65560000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17311,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1268.7973999999999,639.45960000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",773.42460000000005,340.56879999999995,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1193.1815999999999,572.77479999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17314,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",741.86840000000007,314.96659999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",146.4684,90.500799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17340,null,{"$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",191.1234,75.615799999999993,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",47.632000000000005,36.9148,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",879.4058,574.56100000000004,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[19030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",309.608,136.3466,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",955.02159999999992,290.55520000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19082,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",746.03620000000001,146.4684,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19083,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",956.21239999999989,273.28859999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19084,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",735.31899999999996,138.13279999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1476.5920000000001,318.53899999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1153.8851999999999,160.1626,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",281.02879999999999,121.4616,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",611.47579999999994,404.87199999999996,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19105,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",906.19880000000001,643.62739999999997,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",860.35299999999995,590.63679999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",953.83079999999995,756.75340000000006,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1049.0948000000001,835.94159999999999,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",281.02879999999999,281.02879999999999,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM",2,29]
[19281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",454.29019999999997,175.643,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",325.68379999999996,88.714600000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",491.80039999999997,176.8338,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",364.98019999999997,88.714600000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19285,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",710.31219999999996,150.63619999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",586.46899999999994,75.615799999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19287,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1228.3101999999999,223.87039999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",955.02159999999992,112.53059999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19294,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",288.17359999999996,288.17359999999996,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1442.6541999999999,1442.6541999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19318,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1985.6590000000001,1985.6590000000001,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1126.4968000000001,1126.4968000000001,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1013.9662000000001,1013.9662000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1180.0827999999999,1180.0827999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1386.0912000000001,1386.0912000000001,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19342,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1390.259,1390.259,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM",2,29]
[19350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1537.3227999999999,1231.2872,"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",2122.6009999999997,2122.6009999999997,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2822.1959999999999,2822.1959999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19364,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4907.2867999999999,4907.2867999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19367,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3205.6336000000001,3205.6336000000001,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19368,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3917.732,3917.732,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19369,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3641.4663999999998,3641.4663999999998,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1226.5240000000001,1226.5240000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19371,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1300.3535999999999,1300.3535999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19380,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1474.2104000000002,1474.2104000000002,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19396,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",514.42560000000003,257.21280000000002,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19499,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1069.3384000000001,1069.3384000000001,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[20101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1099.7038,375.69739999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1144.9541999999999,455.48099999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1050.2855999999999,623.38380000000006,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1820.1378,1820.1378,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[20200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",409.6352,169.68899999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20205,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.4162,275.67019999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",426.90179999999998,103.0042,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",445.95460000000003,156.59019999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20225,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",731.1511999999999,230.41980000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",250.6634,250.6634,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",615.64359999999999,615.64359999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",704.95359999999994,704.95359999999994,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20251,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",763.30280000000005,763.30280000000005,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[20500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",231.01519999999999,162.54419999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",273.88399999999996,64.898600000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",406.06280000000004,270.3116,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",874.04719999999998,449.52699999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",151.23159999999999,102.4088,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20527,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",161.35339999999999,118.4846,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",106.5766,69.661799999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",106.5766,69.661799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",97.645599999999988,66.68480000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",112.53059999999999,76.211200000000005,"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",48.227400000000003,26.792999999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20561,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",69.661799999999999,39.891800000000003,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",97.645599999999988,63.707800000000006,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",152.42240000000001,82.165199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",101.8134,66.089400000000012,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",165.52119999999999,92.882400000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",118.4846,80.974400000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20611,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",184.57400000000001,107.172,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",118.4846,73.829599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",473.34300000000002,295.3184,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",421.54320000000001,299.4862,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,null,2,29]
[20660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",425.71100000000001,425.71100000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20661,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",952.04459999999995,952.04459999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20662,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",962.16639999999995,962.16639999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20663,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",887.7414,887.7414,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[20664,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1612.3431999999998,1612.3431999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",218.51179999999999,179.8108,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",678.75599999999997,266.1438,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1118.7565999999999,765.08899999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1085.4141999999999,1085.4141999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20692,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2046.3897999999999,2046.3897999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20693,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",813.31640000000004,813.31640000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20694,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",803.19460000000004,629.33780000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20696,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2128.5549999999998,2128.5549999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20697,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3523.5771999999997,3523.5771999999997,"000",0,0,0,3,0,0,2,1,0,null,"R",null,null,2,29]
[20700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",150.63619999999997,150.63619999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",114.9122,114.9122,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20702,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",253.04499999999999,253.04499999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20703,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",182.78779999999998,182.78779999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20704,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",261.38059999999996,261.38059999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",221.4888,221.4888,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4931.1027999999997,4931.1027999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5850.4004000000004,5850.4004000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20808,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7047.7498000000005,7047.7498000000005,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20816,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3692.6708000000003,3692.6708000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3197.8933999999999,3197.8933999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20824,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3699.8155999999999,3699.8155999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20827,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3284.2263999999996,3284.2263999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20838,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5009.6956,5009.6956,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",733.53279999999995,326.2792,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20902,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",494.18200000000002,494.18200000000002,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",880.59659999999997,880.59659999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20912,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",887.14599999999996,887.14599999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",737.10520000000008,737.10520000000008,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[20922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1119.9474,896.67240000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20924,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",927.63319999999999,927.63319999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[20931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",194.10039999999998,194.10039999999998,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[20932,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1340.2454,1340.2454,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1230.6918000000001,1230.6918000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20934,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1339.65,1339.65,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20936,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[20937,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",294.72300000000001,294.72300000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20938,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",321.51600000000002,321.51600000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20939,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",123.8432,123.8432,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR",2,29]
[20950,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",500.13600000000002,158.9718,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[20955,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4446.4472000000005,4446.4472000000005,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20956,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4742.3609999999999,4742.3609999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20957,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4941.82,4941.82,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20962,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4814.4044000000004,4814.4044000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20969,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4903.1189999999997,4903.1189999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20970,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5112.6998000000003,5112.6998000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20972,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5097.8148000000001,5097.8148000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[20973,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5381.2251999999999,5381.2251999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20974,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.61320000000001,92.287000000000006,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR",2,29]
[20975,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",313.77579999999995,313.77579999999995,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20979,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",104.19499999999999,57.753799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR",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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",257.21280000000002,257.21280000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20999,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1362.2751999999998,1362.2751999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",701.38119999999992,481.08319999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",621.59759999999994,621.59759999999994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",999.67659999999989,738.29600000000005,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",956.21239999999989,956.21239999999989,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1276.5376000000001,1276.5376000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",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",1459.3254000000002,1206.8758,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21026,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",993.72260000000006,786.52340000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21029,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1428.3645999999999,1141.9772,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[21030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",856.18520000000001,663.87099999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[21031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",718.64779999999996,503.11299999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[21032,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",694.2364,479.29700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2387.5540000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",868.09320000000002,669.2296,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1576.6192000000001,1576.6192000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2188.6904,2188.6904,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1815.3745999999999,1815.3745999999999,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[21047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2209.5293999999999,2209.5293999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21048,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1824.9009999999998,1824.9009999999998,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[21049,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2089.2586000000001,2089.2586000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1593.2904000000001,1593.2904000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1442.6541999999999,1442.6541999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1123.5198,1123.5198,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",703.16740000000004,443.57299999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[21076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1573.6422,1271.7744,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3854.0242000000003,3127.0408000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21079,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2641.7898,2102.9528,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3041.8986,2389.3402000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2806.7156,2187.4996000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21082,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2592.3715999999999,2000.5440000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21083,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2479.2456000000002,1858.2434000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21084,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2826.9591999999998,2147.6077999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1242.5998,871.66560000000004,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2868.0418,2305.9841999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21087,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2868.0418,2305.9841999999999,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1167.5793999999999,653.15380000000005,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1633.1822,1348.5809999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",413.803,80.974400000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1246.1722,944.30439999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[21121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1171.7472,972.28819999999985,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1381.9234000000001,1381.9234000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21123,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1564.1158,1564.1158,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5008.5048000000006,1215.8068000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21127,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7678.8737999999994,1393.8314,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21137,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1373.5878,1373.5878,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1667.7154,1667.7154,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21139,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1991.0175999999999,1991.0175999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21141,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2442.9261999999999,2442.9261999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21142,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2506.0386000000003,2506.0386000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21143,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2581.0590000000002,2581.0590000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2832.3177999999998,2832.3177999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2957.3517999999999,2957.3517999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3112.1558,3112.1558,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2992.4803999999999,2992.4803999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3290.1803999999997,3290.1803999999997,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21154,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3539.6530000000002,3539.6530000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3921.3044,3921.3044,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21159,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4691.7519999999995,4691.7519999999995,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5084.7160000000003,5084.7160000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21172,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3794.4841999999999,3794.4841999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4000.4925999999996,4000.4925999999996,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21179,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2756.7019999999998,2756.7019999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3076.4317999999998,3076.4317999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1354.5350000000001,1354.5350000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[21182,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3821.8725999999997,3821.8725999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21183,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4155.8919999999998,4155.8919999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21184,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4466.6907999999994,4466.6907999999994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21188,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2898.4072000000001,2898.4072000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21193,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2251.8027999999999,2251.8027999999999,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[21194,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2604.2796000000003,2604.2796000000003,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-UR",2,29]
[21195,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2462.5744,2462.5744,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-UR",2,29]
[21196,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2628.0956000000001,2628.0956000000001,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[21198,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1867.1743999999999,1867.1743999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21199,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1851.694,1851.694,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1772.5057999999999,1772.5057999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3106.2018000000003,1343.8178,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21209,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1534.3458000000001,1147.3358000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3339.0031999999997,1382.5187999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7847.3720000000003,1434.3186000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1365.8476000000001,1365.8476000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1370.6107999999999,1047.904,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1924.9281999999998,1924.9281999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21242,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1857.6479999999999,1857.6479999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21243,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3072.2640000000001,3072.2640000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21244,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1854.0755999999999,1854.0755999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2289.9083999999998,1744.5219999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1554.5893999999998,1554.5893999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21247,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2887.0945999999999,2887.0945999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1809.4205999999999,1440.8679999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21249,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2443.5216,2010.0703999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21255,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2460.1927999999998,2460.1927999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21256,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2255.3751999999999,2255.3751999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21260,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1880.8686,1363.4659999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1540.2998,1540.2998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1081.8418000000001,1081.8418000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",738.89139999999998,738.89139999999998,"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",285.79199999999997,108.95820000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",410.82600000000002,171.4752,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",835.34619999999995,835.34619999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",998.48579999999993,998.48579999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1323.5742,1323.5742,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21336,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",787.71420000000001,559.0806,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21338,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1256.2940000000001,1256.2940000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21339,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1414.6704,1414.6704,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1378.3509999999999,1378.3509999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2008.8796,2008.8796,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2548.3119999999999,2548.3119999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1494.454,1177.1058,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21346,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1908.8524000000002,1908.8524000000002,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21347,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1920.7603999999999,1920.7603999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21348,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1993.9946,1993.9946,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",840.10939999999994,607.30799999999999,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1019.3248000000001,744.25,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",966.92959999999994,966.92959999999994,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1971.9647999999997,1971.9647999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2319.6784000000002,2319.6784000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21385,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1345.0085999999999,1345.0085999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21386,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1264.0342000000001,1264.0342000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21387,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1402.7623999999998,1402.7623999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1472.4241999999999,1472.4241999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1834.4273999999998,1834.4273999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",404.87199999999996,313.77579999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21401,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",960.38019999999995,609.0942,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1072.9107999999999,1072.9107999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21407,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21408,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1646.8763999999999,1646.8763999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21421,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1206.2804000000001,1013.9662000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1155.6713999999999,1155.6713999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21423,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1459.9207999999999,1459.9207999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1290.8271999999999,1290.8271999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21432,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1318.2156,1318.2156,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21433,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3138.9487999999997,3138.9487999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2559.0291999999999,2559.0291999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21436,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3690.8845999999999,3690.8845999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1309.2846,1047.904,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1481.9506000000001,1190.8,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1121.7336,907.38959999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21451,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1453.3714,1207.4712,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21452,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1428.3645999999999,882.97820000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21453,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2073.7781999999997,1758.2162000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21454,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",893.1,893.1,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[21461,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3484.2808,1983.8728000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3765.9049999999997,2186.9041999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1450.3943999999999,1450.3943999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2114.8608000000004,2114.8608000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",270.3116,55.372199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1849.3123999999998,1504.5757999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1428.96,1428.96,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1342.627,1111.6118000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21499,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",915.12979999999993,618.62060000000008,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",914.53440000000001,914.53440000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",820.46119999999996,820.46119999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",502.51759999999996,286.38739999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",811.53020000000004,811.53020000000004,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1324.1695999999999,1324.1695999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",811.53020000000004,563.84379999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",969.3112000000001,969.3112000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[21557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1723.683,1723.683,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21558,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1033.6143999999999,1033.6143999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2044.0081999999998,2044.0081999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21602,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2769.2053999999998,2769.2053999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21603,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3009.7469999999998,3009.7469999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2039.8403999999998,2039.8403999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1104.4670000000001,1104.4670000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1253.9123999999999,1253.9123999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.15279999999996,912.15279999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21627,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",991.93640000000005,991.93640000000005,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2387.5540000000001,2387.5540000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2153.5617999999999,2153.5617999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21685,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",626.36079999999993,626.36079999999993,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",931.2056,931.2056,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",971.69280000000003,971.69280000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",998.48579999999993,998.48579999999993,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1808.8252,1808.8252,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21742,null,{"$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-UR",2,29]
[21743,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-UR",2,29]
[21750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1199.1356000000001,1199.1356000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21811,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1042.5454,1042.5454,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21812,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1264.6296,1264.6296,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21813,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1724.8737999999998,1724.8737999999998,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",284.60120000000001,280.43340000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",996.10419999999999,996.10419999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21899,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",482.27399999999994,284.00579999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21925,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",920.48840000000007,694.2364,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",934.77799999999991,665.06179999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",850.82659999999998,850.82659999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[21932,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1205.0895999999998,1205.0895999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1334.2914000000001,1334.2914000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1835.6181999999999,1835.6181999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[21936,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1754.0484000000001,1754.0484000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[22015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1727.2554,1727.2554,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[22100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1570.0698,1570.0698,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1581.9777999999999,1581.9777999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1417.0520000000001,1417.0520000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",238.75539999999998,238.75539999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1920.165,1920.165,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",247.68639999999999,247.68639999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4366.0681999999997,4366.0681999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22207,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4286.88,4286.88,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1032.4236000000001,1032.4236000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3210.3968,3210.3968,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22212,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2731.6952000000001,2731.6952000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22214,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2731.6952000000001,2731.6952000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22216,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",638.26880000000006,638.26880000000006,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2918.0553999999997,2918.0553999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3161.5740000000001,3161.5740000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22224,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2859.7062000000001,2859.7062000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",632.31479999999999,632.31479999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",577.5379999999999,550.745,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[22315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1634.9684,1412.8842,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[22318,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2957.9472000000001,2957.9472000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22319,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3275.2954,3275.2954,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2660.8425999999999,2660.8425999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2717.4056,2717.4056,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2770.3962000000001,2770.3962000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",495.96820000000002,495.96820000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",235.7784,235.7784,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR",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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3219.9231999999997,3219.9231999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22533,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2979.3815999999997,2979.3815999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22534,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",634.101,634.101,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22548,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3512.2646,3512.2646,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3043.0893999999998,3043.0893999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",696.02260000000001,696.02260000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2270.2602000000002,2270.2602000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2997.2436000000002,2997.2436000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22558,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2735.2675999999997,2735.2675999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",572.17939999999999,572.17939999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22586,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3630.7491999999997,3630.7491999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2854.9430000000002,2854.9430000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22595,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2725.7411999999999,2725.7411999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2348.2575999999999,2348.2575999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2312.5336000000002,2312.5336000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2844.2258000000002,2844.2258000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22614,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",687.09159999999997,687.09159999999997,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2792.4259999999999,2792.4259999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",562.65299999999991,562.65299999999991,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22633,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3236.5944,3236.5944,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",850.82659999999998,850.82659999999998,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2466.1468,2466.1468,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3793.2934,3793.2934,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4352.9694,4352.9694,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22808,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3266.3643999999999,3266.3643999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3612.2918,3612.2918,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22812,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3960.0054000000005,3960.0054000000005,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22818,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3859.3827999999994,3859.3827999999994,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22819,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4445.2563999999993,4445.2563999999993,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1488.5,1488.5,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1332.5051999999998,1332.5051999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-UR",2,29]
[22842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1341.4362000000001,1341.4362000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22843,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1436.1048000000001,1436.1048000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22844,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1737.3771999999999,1737.3771999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22845,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1276.5376000000001,1276.5376000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22846,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1328.3373999999999,1328.3373999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22847,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1419.4336000000001,1419.4336000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22848,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",633.50560000000007,633.50560000000007,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22849,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2345.8759999999997,2345.8759999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22850,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1333.6959999999999,1333.6959999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1284.8731999999998,1284.8731999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22853,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",453.69479999999999,453.69479999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22854,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",588.85059999999999,588.85059999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22855,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1996.3761999999999,1996.3761999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22856,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2909.7197999999999,2909.7197999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22857,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3184.1991999999996,3184.1991999999996,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22858,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",891.31380000000001,891.31380000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22859,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",585.27819999999997,585.27819999999997,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,2,2,0,null,"X",null,null,2,29]
[22861,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4119.5725999999995,4119.5725999999995,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22862,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4127.9081999999999,4127.9081999999999,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22864,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3683.7397999999998,3683.7397999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22865,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4030.8580000000002,4030.8580000000002,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22867,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1937.4315999999999,1937.4315999999999,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22868,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",428.0926,428.0926,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22869,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",785.928,785.928,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22870,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",211.36699999999999,211.36699999999999,"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",1024.6834000000001,1024.6834000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1201.5172,1201.5172,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22902,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",877.61959999999999,609.0942,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22903,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",799.02679999999998,799.02679999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22904,null,{"$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-UR",2,29]
[23000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1033.6143999999999,659.1078,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1268.202,1268.202,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",827.01060000000007,465.6028,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[23031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",820.46119999999996,409.03980000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1253.317,1253.317,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1318.2156,1318.2156,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1046.7131999999999,1046.7131999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23065,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1062.789,676.96979999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",764.49360000000001,764.49360000000001,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[23073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1265.8204000000001,1265.8204000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",966.92959999999994,603.14020000000005,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",994.31799999999998,994.31799999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23077,null,{"$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",940.13659999999993,940.13659999999993,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",847.84960000000001,847.84960000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1177.1058,1177.1058,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",932.39639999999997,932.39639999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1217.5929999999998,1217.5929999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1086.605,1086.605,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1304.5214000000001,1304.5214000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1143.7634,1143.7634,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1027.0650000000001,1027.0650000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1279.5146,1279.5146,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1150.9081999999999,1150.9081999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[23150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1228.3101999999999,1228.3101999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1464.0886,1464.0886,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1249.7446,1249.7446,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1043.7362000000001,1043.7362000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23172,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1055.0488,1055.0488,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23174,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1405.7393999999999,1405.7393999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1211.0436,1211.0436,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23182,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.2181999999998,1240.2181999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23184,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1361.6798000000001,1361.6798000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23190,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1063.3843999999999,1063.3843999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23195,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1362.2751999999998,1362.2751999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23200,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",569.79780000000005,309.01260000000002,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[23333,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",875.23799999999994,875.23799999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[23334,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1922.5465999999999,1922.5465999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2295.2669999999998,2295.2669999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",312.58499999999998,89.31,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[23395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2329.2048,2329.2048,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23397,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2068.4196000000002,2068.4196000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1774.2919999999999,1774.2919999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1133.0462,1133.0462,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1367.6337999999998,1367.6337999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[23410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1501.5988,1501.5988,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1558.1618000000001,1558.1618000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1285.4685999999999,1285.4685999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1780.2459999999999,1780.2459999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1365.8476000000001,1365.8476000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1384.3050000000001,1384.3050000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1721.8968,1721.8968,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1798.1079999999999,1798.1079999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1982.6819999999998,1982.6819999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1938.6224000000002,1938.6224000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2032.6956,2032.6956,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23466,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2044.6036000000001,2044.6036000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2170.8283999999999,2170.8283999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23472,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2612.6152000000002,2612.6152000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23473,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2904.9566,2904.9566,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23474,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3132.9947999999999,3132.9947999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1499.8126,1499.8126,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[23485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1736.7818,1736.7818,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1572.4513999999999,1572.4513999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[23491,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1850.5031999999999,1850.5031999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",426.90179999999998,436.4282,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",679.94679999999994,629.33780000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1325.3604,1325.3604,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",459.64879999999999,454.29019999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",753.77639999999997,687.09159999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1064.5752,1064.5752,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23532,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1156.2668000000001,1156.2668000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",457.2672,451.90859999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",685.30539999999996,611.47579999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1056.835,1056.835,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1192.5862,1192.5862,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",447.1454,462.03039999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",777.5924,715.07539999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1778.4598000000001,1778.4598000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",637.67340000000002,602.5447999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",887.7414,801.40840000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1615.3201999999999,1615.3201999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2241.0855999999999,2241.0855999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[23620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",518.59340000000009,495.96820000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23625,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",735.31899999999996,669.82500000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1433.1278,1433.1278,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",629.33780000000002,565.03459999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23655,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",763.30280000000005,763.30280000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1083.6279999999999,1083.6279999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",820.46119999999996,750.20399999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1592.0995999999998,1592.0995999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1034.8052,932.39639999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1696.8899999999999,1696.8899999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",360.81239999999997,360.81239999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1870.1514,1870.1514,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2330.991,2330.991,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2506.0386000000003,2506.0386000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[23920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2040.4358000000002,2040.4358000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23921,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",874.04719999999998,874.04719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23929,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,0,2,0,2,1,1,null,"B",null,"Y-UR",2,29]
[23930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",675.779,392.964,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",575.7518,298.89079999999996,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",952.04459999999995,952.04459999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",886.55060000000003,886.55060000000003,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR",2,29]
[24006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1309.2846,1309.2846,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[24065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",485.84640000000002,298.29539999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[24066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1168.7701999999999,775.80619999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",738.89139999999998,738.89139999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1258.6756,1258.6756,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1002.6536,607.30799999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1003.8444,1003.8444,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",781.1647999999999,781.1647999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",936.56420000000003,936.56420000000003,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1136.0231999999999,1136.0231999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",675.779,675.779,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1091.9636,1091.9636,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1353.3442,1353.3442,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1570.6651999999999,1570.6651999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",986.57780000000002,986.57780000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.1220000000001,1149.1220000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1199.1356000000001,1199.1356000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",952.04459999999995,952.04459999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[24134,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1371.8016,1371.8016,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1165.7931999999998,1165.7931999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1272.9651999999999,1272.9651999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1293.8042,1293.8042,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.3222000000001,1097.3222000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1165.1977999999999,1165.1977999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24149,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2158.9204,2158.9204,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1556.3756000000001,1556.3756000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2279.1912000000002,2279.1912000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24164,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1328.9328,1328.9328,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",405.4674,256.61739999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[24201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1029.4466,676.96979999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",362.59859999999998,119.08,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[24300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",824.03359999999998,824.03359999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1380.7326,1380.7326,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1070.5291999999999,1070.5291999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",881.19200000000001,881.19200000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1429.5554,1429.5554,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1319.4064000000001,1319.4064000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24331,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1438.4864,1438.4864,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1137.8093999999999,1137.8093999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[24340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1107.444,1107.444,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1380.1371999999999,1380.1371999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24342,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.8381999999999,1418.8381999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1320.0018,1320.0018,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1996.9715999999999,1996.9715999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1311.6662000000001,1311.6662000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24346,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2017.8106,2017.8106,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",778.18780000000004,778.18780000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",981.2192,981.2192,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24359,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1221.1654000000001,1221.1654000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1649.8534,1649.8534,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1836.2136,1836.2136,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24362,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1930.8822,1930.8822,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24363,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2620.9508000000001,2620.9508000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1179.4874,1179.4874,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1251.5308,1251.5308,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2781.1134000000002,2781.1134000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24371,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3188.3669999999997,3188.3669999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1517.0791999999999,1517.0791999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24410,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1957.6752000000001,1957.6752000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1921.9512,1921.9512,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1970.7740000000001,1970.7740000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1237.8365999999999,1237.8365999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1736.1864,1736.1864,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24498,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1583.1686,1583.1686,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",690.66399999999999,635.29179999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",950.85379999999998,848.44499999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1613.5340000000001,1613.5340000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24516,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1569.4743999999998,1569.4743999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",730.55579999999998,666.84799999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1163.4115999999999,1063.3843999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24538,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1460.5162,1460.5162,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1693.3176000000001,1693.3176000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1888.6088,1888.6088,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",638.26880000000006,562.65299999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1020.5156000000001,927.63319999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24566,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1331.9098000000001,1331.9098000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1347.9856,1347.9856,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",672.80200000000002,597.18619999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24577,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1048.4993999999999,950.85379999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24579,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1530.7734,1530.7734,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24582,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1508.7436,1508.7436,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24586,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1977.3234,1977.3234,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24587,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1979.7049999999999,1979.7049999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",713.28920000000005,641.84119999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",893.1,893.1,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1311.6662000000001,1311.6662000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1092.559,1092.559,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1247.9584,1247.9584,"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",506.68539999999996,469.7706,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24655,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",849.04039999999998,761.51659999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1215.2113999999999,1215.2113999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24666,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1347.3901999999998,1347.3901999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",559.67600000000004,510.25780000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",871.0702,784.73719999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1207.4712,1207.4712,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1527.7963999999999,1527.7963999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1827.2826,1827.2826,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1349.7718,1349.7718,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1344.4132,1344.4132,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24925,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1053.2626,1053.2626,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1415.2657999999999,1415.2657999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1695.1037999999999,1695.1037999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2238.1086,2238.1086,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2043.8668358222403,2043.8668358222403,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"F",null,"Y-UR",2,29]
[24999,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",650.7722,650.7722,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",649.58140000000003,649.58140000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1403.3578,1403.3578,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25023,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2431.0182,2431.0182,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25024,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.2428,1418.2428,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2227.9868000000001,2227.9868000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25028,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1308.6892,1308.6892,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",687.68700000000001,687.68700000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1083.6279999999999,1083.6279999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1031.8281999999999,1031.8281999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",481.08319999999998,290.55520000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[25066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",684.71,684.71,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.61540000000002,774.61540000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",987.17319999999984,987.17319999999984,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",980.02840000000003,584.0874,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",959.78480000000002,959.78480000000002,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",832.96460000000002,832.96460000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",654.34460000000001,654.34460000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",754.96719999999993,754.96719999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.38959999999997,907.38959999999997,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1145.5495999999998,1145.5495999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25109,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",993.72260000000006,993.72260000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",648.98599999999999,648.98599999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",609.68960000000004,609.68960000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",728.17420000000004,728.17420000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1394.4268000000002,1394.4268000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1119.9474,1119.9474,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25118,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",715.07539999999995,715.07539999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25119,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",932.99180000000001,932.99180000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",932.39639999999997,932.39639999999997,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1100.8945999999999,1100.8945999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1108.6348,1108.6348,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",841.89560000000006,841.89560000000006,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1037.7821999999999,1037.7821999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",924.6561999999999,924.6561999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",966.33420000000001,966.33420000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1049.6902,1049.6902,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1081.2464,1081.2464,"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",917.51139999999998,917.51139999999998,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1145.5495999999998,1145.5495999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",806.1715999999999,806.1715999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",800.81299999999999,800.81299999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",373.31579999999997,129.7972,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[25248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",769.85219999999993,769.85219999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",988.95939999999996,988.95939999999996,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25251,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1321.788,1321.788,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25259,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",815.69799999999998,815.69799999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1177.7012,1177.7012,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25263,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1172.9379999999999,1172.9379999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1381.328,1381.328,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",918.70219999999995,918.70219999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1035.9959999999999,1035.9959999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1228.9056,1228.9056,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.2181999999998,1240.2181999999998,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1047.904,1047.904,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25290,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",810.9348,810.9348,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",978.24220000000003,978.24220000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1273.5606,1273.5606,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1187.8229999999999,1187.8229999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.7174,1149.7174,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1320.5971999999999,1320.5971999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1411.098,1411.098,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25316,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1674.2647999999999,1674.2647999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1820.7331999999999,1820.7331999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[25332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1550.4215999999999,1550.4215999999999,"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",1635.5637999999999,1635.5637999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1244.9813999999999,1244.9813999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1402.7623999999998,1402.7623999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1209.8527999999999,1209.8527999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1676.0509999999999,1676.0509999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1850.5031999999999,1850.5031999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25375,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1740.9495999999999,1740.9495999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1411.6934000000001,1411.6934000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25391,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1815.3745999999999,1815.3745999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1846.9307999999999,1846.9307999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25393,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2051.1530000000002,2051.1530000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25394,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1437.2955999999999,1437.2955999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1471.8288,1471.8288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1890.395,1890.395,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1765.9564,1765.9564,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2117.2424000000001,2117.2424000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1758.2162000000001,1758.2162000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2039.8403999999998,2039.8403999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1346.7948000000001,1346.7948000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1443.845,1443.845,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1411.098,1411.098,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25441,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1713.5612000000001,1713.5612000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1486.7138,1486.7138,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25443,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1442.6541999999999,1442.6541999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25444,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1518.27,1518.27,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1326.5512000000001,1326.5512000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2132.7228,2132.7228,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25447,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1531.3688,1531.3688,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25449,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1885.0364,1885.0364,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1140.7864,1140.7864,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1345.0085999999999,1345.0085999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1321.788,1321.788,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25491,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.3212000000001,1356.3212000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25492,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1657.5935999999999,1657.5935999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",544.79100000000005,491.20499999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",959.78480000000002,866.90240000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1236.0504000000001,1236.0504000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1084.2234000000001,1018.134,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1455.7529999999999,1455.7529999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1750.4759999999999,1750.4759999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",507.28079999999994,464.41199999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",935.96879999999999,859.16219999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1157.4576,1157.4576,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",556.10360000000003,494.18200000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",981.81459999999993,872.85640000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25574,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1247.9584,1247.9584,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1658.7844,1658.7844,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",650.7722,621.00220000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1016.3478,957.40319999999986,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1239.0273999999999,1239.0273999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1366.443,1366.443,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25608,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1522.4377999999999,1522.4377999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25609,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1928.5006000000001,1928.5006000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25622,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",589.44600000000003,543.00479999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25624,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",931.2056,840.10939999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25628,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1325.3604,1325.3604,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",584.0874,541.81399999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",882.97820000000002,797.24059999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1057.4304000000002,1057.4304000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",632.31479999999999,583.49200000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25651,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",913.93899999999996,913.93899999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25652,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1152.6943999999999,1152.6943999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",843.68179999999995,843.68179999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1124.1152,1124.1152,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25671,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",988.36400000000003,988.36400000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.92539999999997,774.61540000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1165.1977999999999,1165.1977999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",991.34099999999989,991.34099999999989,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1349.7718,1349.7718,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",919.89299999999992,919.89299999999992,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25695,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1168.7701999999999,1168.7701999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1346.7948000000001,1346.7948000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1552.8031999999998,1552.8031999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1590.9087999999999,1590.9087999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1209.2574,1209.2574,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1471.8288,1471.8288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1890.395,1890.395,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1317.0248000000001,1317.0248000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25905,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1288.4456,1288.4456,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25907,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1133.6415999999999,1133.6415999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25909,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1260.4618,1260.4618,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25915,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2114.2653999999998,2114.2653999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1351.558,1351.558,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1200.9218000000001,1200.9218000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25924,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1320.0018,1320.0018,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25927,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1614.7248,1614.7248,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25929,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1105.6578,1105.6578,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1498.0264,1498.0264,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25999,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",658.51240000000007,261.976,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",920.48840000000007,343.54579999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1032.4236000000001,1032.4236000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",779.97399999999993,779.97399999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",910.96199999999999,910.96199999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1024.6834000000001,1024.6834000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1581.3824,1581.3824,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26037,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1035.4005999999999,1035.4005999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",594.20920000000001,594.20920000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",879.4058,879.4058,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1128.8784000000001,546.57719999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.70159999999993,478.70159999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",603.73559999999998,603.73559999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",634.69640000000004,634.69640000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",746.03620000000001,746.03620000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",635.88720000000001,635.88720000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",640.65039999999999,640.65039999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",610.88040000000001,610.88040000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",767.47059999999999,767.47059999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26113,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1010.3937999999999,1010.3937999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1041.3545999999999,617.4298,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",972.8836,972.8836,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1110.4209999999998,1110.4209999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26123,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1546.2538,1546.2538,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",480.48779999999999,480.48779999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",874.04719999999998,874.04719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1027.6604,1027.6604,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",943.70899999999995,943.70899999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",958.59400000000005,958.59400000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1173.5334,591.23219999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",762.70740000000001,762.70740000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",839.51400000000001,839.51400000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26185,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1036.5914,1036.5914,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.91859999999997,838.91859999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26205,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1116.9704000000002,1116.9704000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",836.53700000000003,836.53700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1050.8809999999999,1050.8809999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",927.63319999999999,927.63319999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",913.93899999999996,913.93899999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26236,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",819.86579999999992,819.86579999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1938.6224000000002,1938.6224000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1456.3484000000001,1456.3484000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1160.4345999999998,1160.4345999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",653.15380000000005,653.15380000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",673.99279999999999,673.99279999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",221.4888,144.68219999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[26350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1415.8612000000001,1415.8612000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26352,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1571.856,1571.856,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1477.1873999999998,1477.1873999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1647.4718,1647.4718,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1811.2068000000002,1811.2068000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1481.3552,1481.3552,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1719.5151999999998,1719.5151999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26373,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1658.1890000000001,1658.1890000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1642.1131999999998,1642.1131999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1873.1284000000001,1873.1284000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1144.3588,1144.3588,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.3212000000001,1356.3212000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1599.2444,1599.2444,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26416,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1725.4692,1725.4692,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26418,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1191.3954000000001,1191.3954000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1402.7623999999998,1402.7623999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",936.56420000000003,936.56420000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26428,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1502.7895999999998,1502.7895999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26432,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1037.7821999999999,1037.7821999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26433,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1088.9866,1088.9866,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26434,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.2385999999999,1315.2385999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26437,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1262.8434,1262.8434,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1238.432,1238.432,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1860.625,1860.625,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1158.0529999999999,1158.0529999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26449,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1296.1858,1296.1858,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",884.16899999999998,884.16899999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",879.4058,879.4058,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.58979999999997,855.58979999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26471,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1250.3399999999999,1250.3399999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26474,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1236.6458,1236.6458,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26476,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1221.1654000000001,1221.1654000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26477,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1187.8229999999999,1187.8229999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26478,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1256.2940000000001,1256.2940000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26479,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1278.9192,1278.9192,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1486.7138,1486.7138,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26483,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1639.1362000000001,1639.1362000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1576.6192000000001,1576.6192000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26489,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1807.6343999999999,1807.6343999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1573.6422,1573.6422,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26492,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1735.5909999999999,1735.5909999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26494,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1579.5962,1579.5962,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1695.6992,1695.6992,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1693.913,1693.913,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26498,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2185.1179999999999,2185.1179999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1633.7776000000001,1633.7776000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1253.317,1253.317,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1423.6014,1423.6014,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26508,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1280.7054000000001,1280.7054000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1217.5929999999998,1217.5929999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26516,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1400.9762000000001,1400.9762000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26517,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1624.2512000000002,1624.2512000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26518,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1643.8994,1643.8994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1297.972,1297.972,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1302.7351999999998,1302.7351999999998,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1001.4628,1001.4628,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1169.3656000000001,1169.3656000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",816.29340000000002,816.29340000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26536,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.8381999999999,1418.8381999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1321.788,1321.788,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[26541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1563.5204000000001,1563.5204000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26542,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1361.0844,1361.0844,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1381.9234000000001,1381.9234000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1943.981,1943.981,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26548,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1503.9804000000001,1503.9804000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3037.1353999999997,3037.1353999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5971.8620000000001,5971.8620000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5931.9701999999997,5931.9701999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6894.732,6894.732,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2563.7924000000003,2563.7924000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6171.3209999999999,6171.3209999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1205.0895999999998,1205.0895999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26561,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1832.0457999999999,1832.0457999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26562,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2544.7395999999999,2544.7395999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1346.1994,1346.1994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26567,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.9166,1356.9166,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26568,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1747.499,1747.499,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26580,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",931.2056,931.2056,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26593,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1222.9515999999999,1222.9515999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26596,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1526.0101999999999,1526.0101999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",577.5379999999999,548.9588,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",631.71939999999995,566.82079999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",954.42620000000011,954.42620000000011,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26608,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",900.84019999999998,900.84019999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1068.7429999999999,1068.7429999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",796.04979999999989,721.02940000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",819.86579999999992,743.05920000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",904.4126,904.4126,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1163.4115999999999,1163.4115999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[26670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",660.89400000000001,587.06439999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",874.6425999999999,794.2636,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",956.21239999999989,956.21239999999989,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1068.7429999999999,1068.7429999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.7174,1149.7174,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",644.81820000000005,590.63679999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",830.58299999999997,747.82240000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26706,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",836.53700000000003,836.53700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1065.1705999999999,1065.1705999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",385.81920000000002,361.40780000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",651.36759999999992,576.34719999999993,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26727,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",888.93219999999997,888.93219999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26735,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1103.2762,1103.2762,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",446.55,422.73399999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26742,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",710.31219999999996,634.101,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26746,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1368.8245999999999,1368.8245999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",359.6216,363.19399999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26755,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",610.28499999999997,519.78420000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",799.02679999999998,799.02679999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26765,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",938.94579999999996,938.94579999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",546.57719999999995,495.37279999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26775,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",753.18100000000004,672.20659999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26776,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",844.87259999999992,844.87259999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26785,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1020.5156000000001,1020.5156000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1557.5663999999999,1557.5663999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1456.3484000000001,1456.3484000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[26842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1562.3295999999998,1562.3295999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26843,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1470.6379999999999,1470.6379999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26844,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1612.9386,1612.9386,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26850,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1384.9004,1384.9004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1564.7112,1564.7112,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1164.6024,1164.6024,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26861,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",180.40619999999998,180.40619999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26862,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1442.0588,1442.0588,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26863,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",406.65820000000002,406.65820000000002,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[26910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1433.1278,1433.1278,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26951,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1325.9558,1325.9558,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26952,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1291.4226000000001,1291.4226000000001,"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",1259.8663999999999,1259.8663999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26991,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1325.3604,970.50200000000007,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26992,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1845.1445999999999,1845.1445999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[27000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",726.38799999999992,726.38799999999992,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",996.69959999999992,996.69959999999992,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1105.6578,1105.6578,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1311.0708,1311.0708,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1307.4983999999999,1307.4983999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1682.0049999999999,1682.0049999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27027,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1623.6558,1623.6558,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1704.0348000000001,1704.0348000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27033,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1767.7426,1767.7426,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2067.8241999999996,2067.8241999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1854.0755999999999,1854.0755999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",636.48259999999993,362.59859999999998,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1297.3765999999998,1297.3765999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27043,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",850.82659999999998,850.82659999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1333.1006,1333.1006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",919.29759999999999,658.51240000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27048,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1112.2072000000001,1112.2072000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27049,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",754.37180000000001,754.37180000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1068.7429999999999,1068.7429999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27054,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1267.6065999999998,1267.6065999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1830.855,1830.855,"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",862.7346,862.7346,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27062,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",841.89560000000006,841.89560000000006,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",976.4559999999999,976.4559999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1503.385,1503.385,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27067,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1887.4179999999999,1887.4179999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1627.8235999999999,1627.8235999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1793.9402,1793.9402,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3740.8981999999996,3740.8981999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4514.3227999999999,4514.3227999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5028.1530000000002,5028.1530000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27078,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3688.5030000000002,3688.5030000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",935.37340000000006,935.37340000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",589.44600000000003,311.39420000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27087,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1119.9474,1119.9474,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27090,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1520.0562,1520.0562,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27091,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2873.4004,2873.4004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27093,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",445.95460000000003,122.05699999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27095,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",595.99540000000002,146.4684,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27096,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",304.24940000000004,148.85,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27097,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1256.2940000000001,1256.2940000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27098,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1278.9192,1278.9192,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1521.8424,1521.8424,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1592.6949999999999,1592.6949999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1770.7195999999999,1770.7195999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1650.4487999999999,1650.4487999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2353.0208000000002,2353.0208000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2002.9256,2002.9256,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2319.6784000000002,2319.6784000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27132,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3011.5331999999999,3011.5331999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27134,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3419.9775999999997,3419.9775999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27137,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2639.4081999999999,2639.4081999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2740.0308,2740.0308,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1633.7776000000001,1633.7776000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2297.0531999999998,2297.0531999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2641.7898,2641.7898,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2853.1568000000002,2853.1568000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3071.0731999999998,3071.0731999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27158,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2529.2592,2529.2592,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,null,2,29]
[27161,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2212.5063999999998,2212.5063999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27165,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2491.1536000000001,2491.1536000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2120.8147999999997,2120.8147999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1219.3792000000001,1219.3792000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[27176,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1684.3865999999998,1684.3865999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27177,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2028.5278000000001,2028.5278000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27178,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1684.3865999999998,1684.3865999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27179,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1783.8184000000001,1783.8184000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2035.0771999999999,2035.0771999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27185,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1319.4064000000001,1319.4064000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[27187,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1814.7791999999999,1814.7791999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27197,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",247.09100000000001,247.09100000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[27198,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",572.77479999999991,572.77479999999991,"000",0,0,0,0,2,0,0,2,0,null,"R",null,null,2,29]
[27200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",353.07219999999995,356.64460000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[27202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",967.52499999999998,967.52499999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[27215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.9176,1097.9176,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27216,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1622.4649999999999,1622.4649999999999,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27217,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1526.0101999999999,1526.0101999999999,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27218,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2088.6632,2088.6632,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.02,761.51659999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1795.1309999999999,1795.1309999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1915.9972,1915.9972,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2974.0230000000001,2974.0230000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27228,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3377.1088,3377.1088,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.98500000000001,889.52760000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27232,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1313.4523999999999,1313.4523999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1651.0442,1651.0442,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27236,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2162.4928,2162.4928,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27238,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",869.28399999999999,869.28399999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1742.1404,1742.1404,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27244,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2223.819,2223.819,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2222.0328,2222.0328,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",728.17420000000004,719.83859999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1358.1073999999999,1358.1073999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",316.1574,316.1574,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27252,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1372.9923999999999,1372.9923999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27253,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1712.3704,1712.3704,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27254,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2303.0072,2303.0072,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27256,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",576.34719999999993,431.06959999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27257,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",654.93999999999994,654.93999999999994,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27258,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2019.5968,2019.5968,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27259,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2787.6628000000001,2787.6628000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.61540000000002,774.61540000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27266,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1077.0786000000001,1077.0786000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27267,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",819.2704,819.2704,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27268,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1005.6306000000001,1005.6306000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27269,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2241.681,2241.681,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",338.7826,338.7826,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[27279,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1474.2104000000002,1474.2104000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2444.7123999999999,2444.7123999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1573.6422,1573.6422,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2884.7130000000002,2884.7130000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2962.1149999999998,2962.1149999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27290,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2934.1311999999998,2934.1311999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2268.4740000000002,2268.4740000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27299,null,{"$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,"Y-UR",2,29]
[27301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1253.9123999999999,931.80100000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27303,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",896.077,896.077,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",622.19299999999998,622.19299999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",756.1579999999999,756.1579999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1345.0085999999999,1345.0085999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27323,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",513.83019999999999,321.51600000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27324,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",757.34879999999998,757.34879999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1044.3316,1044.3316,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",968.71579999999994,968.71579999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",942.51819999999998,579.32420000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1136.6186,1136.6186,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27329,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1879.6777999999999,1879.6777999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",785.33259999999996,785.33259999999996,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27331,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",883.57359999999994,883.57359999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1190.2045999999998,1190.2045999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27333,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1089.5820000000001,1089.5820000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27334,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1264.0342000000001,1264.0342000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1403.3578,1403.3578,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",763.89819999999997,763.89819999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27339,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1365.2521999999999,1365.2521999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",698.99959999999999,698.99959999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",900.24479999999994,900.24479999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27347,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",976.4559999999999,976.4559999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1206.2804000000001,1206.2804000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1121.7336,1121.7336,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1358.7028,1358.7028,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1501.5988,1501.5988,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",487.63259999999997,487.63259999999997,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1665.3337999999999,1665.3337999999999,"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",3686.7168000000001,3686.7168000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27369,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",355.4538,72.043399999999991,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1103.2762,737.10520000000008,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27380,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1158.6484,1158.6484,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27381,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1511.1251999999999,1511.1251999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27385,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1130.0691999999999,1130.0691999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27386,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1576.6192000000001,1576.6192000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",835.94159999999999,835.94159999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27391,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1071.72,1071.72,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[27392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1310.4754,1310.4754,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27393,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",928.22860000000003,928.22860000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27394,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1203.3034,1203.3034,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1613.5340000000001,1613.5340000000001,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27396,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1140.7864,1140.7864,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27397,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1672.4785999999999,1672.4785999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1279.5146,1279.5146,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27403,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1243.1951999999999,1243.1951999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27407,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1461.1116,1461.1116,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27409,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1764.7655999999999,1764.7655999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27412,null,{"$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,"Y-UR",2,29]
[27415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2489.3674000000001,2489.3674000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27416,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1783.8184000000001,1783.8184000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[27418,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1518.27,1518.27,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1368.8245999999999,1368.8245999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1361.0844,1361.0844,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27424,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1374.1831999999999,1374.1831999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",844.87259999999992,844.87259999999992,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27427,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1303.9259999999999,1303.9259999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27428,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2037.4587999999999,2037.4587999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27429,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2295.8624,2295.8624,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1361.6798000000001,1361.6798000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1487.3091999999999,1487.3091999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27437,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1215.8068000000001,1215.8068000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27438,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1535.5365999999999,1535.5365999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1460.5162,1460.5162,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27441,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1506.9574,1506.9574,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1590.9087999999999,1590.9087999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27443,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1492.6677999999999,1492.6677999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2271.451,2271.451,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2077.9459999999999,2077.9459999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27447,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2317.2968000000001,2317.2968000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27448,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1513.5068000000001,1513.5068000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1849.3123999999998,1849.3123999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27454,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2343.4944,2343.4944,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1756.43,1756.43,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27457,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1746.9035999999999,1746.9035999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2260.1383999999998,2260.1383999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27466,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2150.5847999999996,2150.5847999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27468,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2427.4458,2427.4458,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2143.44,2143.44,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27472,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2293.4808000000003,2293.4808000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27475,null,{"$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,"Y-UR",2,29]
[27477,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,"Y-UR",2,29]
[27479,null,{"$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,"Y-UR",2,29]
[27485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X",null,"Y-UR",2,29]
[27486,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2537.5947999999999,2537.5947999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27487,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3156.8108000000002,3156.8108000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27488,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2177.3778000000002,2177.3778000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2052.3438000000001,2052.3438000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1015.7524,1015.7524,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1068.1476,1068.1476,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R",null,null,2,29]
[27498,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1210.4481999999998,1210.4481999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1290.8271999999999,1290.8271999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",975.86059999999998,891.90920000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",938.35039999999992,921.67920000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1376.5648000000001,1376.5648000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27503,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1466.4702,1466.4702,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27506,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2426.2550000000001,2426.2550000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27507,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1754.0484000000001,1754.0484000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27508,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",981.2192,927.03779999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27509,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1254.5078000000001,1254.5078000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1247.9584,1247.9584,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27511,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1802.8712,1802.8712,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27513,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2227.9868000000001,2227.9868000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27514,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1748.6898000000001,1748.6898000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27516,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",974.07439999999997,907.98500000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27517,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1271.7744,1271.7744,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27519,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1615.9156,1615.9156,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",621.59759999999994,572.77479999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27524,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1381.328,1381.328,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",589.44600000000003,551.93579999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27532,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1153.8851999999999,1071.1245999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1626.0373999999999,1626.0373999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27536,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2153.5617999999999,2153.5617999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27538,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.7482,845.46799999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1491.4770000000001,1491.4770000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",965.14340000000004,881.78740000000005,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1590.3134,1590.3134,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1888.6088,1888.6088,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27558,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2145.2262000000001,2145.2262000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",709.12139999999999,645.41359999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27562,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.7482,912.7482,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27566,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1627.8235999999999,1627.8235999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",284.00579999999997,284.00579999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2680.4908,2680.4908,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1389.0681999999999,1389.0681999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27591,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1755.8345999999999,1755.8345999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27592,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1194.3724,1194.3724,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27594,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.98500000000001,907.98500000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27596,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1277.7284,1277.7284,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27598,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1243.7906,1243.7906,"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",728.17420000000004,728.17420000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",807.95780000000002,807.95780000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27602,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",851.42200000000003,851.42200000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27603,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",985.38700000000006,718.05240000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.32320000000004,590.63679999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",616.83439999999996,334.6148,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",492.99119999999994,492.99119999999994,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,null,2,29]
[27607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1093.7498000000001,1093.7498000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1182.4643999999998,1182.4643999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1039.5684000000001,1039.5684000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27613,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",471.55680000000001,294.12760000000003,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27614,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.9176,763.30280000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27615,null,{"$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",915.12979999999993,562.65299999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27619,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.58979999999997,855.58979999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",818.07960000000003,818.07960000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27625,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1047.904,1047.904,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1116.375,1116.375,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1000.8673999999999,653.74919999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",746.63159999999993,746.63159999999993,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1229.501,1229.501,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1064.5752,1064.5752,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27637,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.9166,1356.9166,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27638,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1365.8476000000001,1365.8476000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27640,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1516.4838,1516.4838,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1191.3954000000001,1191.3954000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3182.413,3182.413,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27646,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2770.3962000000001,2770.3962000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27647,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1785.0092,1785.0092,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27648,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",409.6352,91.096199999999996,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[27650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1209.2574,1209.2574,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27652,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1208.662,1208.662,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27654,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1308.6892,1308.6892,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27656,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1007.4168000000001,638.86419999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27658,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",680.54219999999998,680.54219999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27659,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",862.13919999999996,862.13919999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27664,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",671.61119999999994,671.61119999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[27665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",776.40159999999992,776.40159999999992,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.7482,912.7482,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1111.0164,1111.0164,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",769.2568,769.2568,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[27681,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",928.22860000000003,928.22860000000003,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1222.9515999999999,855.58979999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",965.73879999999997,965.73879999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27687,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",834.15539999999999,834.15539999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1170.5563999999999,1170.5563999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27691,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1362.2751999999998,1362.2751999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27692,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",178.02460000000002,178.02460000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[27695,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",891.31380000000001,891.31380000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27696,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1003.249,1003.249,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27698,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1169.9609999999998,1169.9609999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1116.375,1116.375,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27702,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1747.499,1747.499,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27703,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2016.6197999999997,2016.6197999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27704,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1043.1407999999999,1043.1407999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1377.7556,1377.7556,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27707,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",753.18100000000004,753.18100000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27709,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2055.9162000000001,2055.9162000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27712,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2003.521,2003.521,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1949.3396,1949.3396,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1595.0765999999999,1595.0765999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27722,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1635.5637999999999,1635.5637999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27724,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2266.0924,2266.0924,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2209.5293999999999,2209.5293999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27726,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1740.3542,1740.3542,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27727,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1084.8188,1084.8188,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[27732,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",843.68179999999995,843.68179999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27734,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1210.4481999999998,1210.4481999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1300.3535999999999,1300.3535999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27742,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1424.7921999999999,1424.7921999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27745,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1382.5187999999998,1382.5187999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",661.48939999999993,612.07119999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27752,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1003.8444,913.34359999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1066.3614,1066.3614,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27758,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1636.7546,1636.7546,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27759,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1813.5884000000001,1813.5884000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",632.91020000000003,581.70579999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27762,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",910.36659999999995,817.48419999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27766,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1119.9474,1119.9474,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27767,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",556.69899999999996,554.31740000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27768,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.91859999999997,838.91859999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27769,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1331.3144,1331.3144,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",591.23219999999992,542.40940000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27781,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",828.79679999999996,759.13499999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27784,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1304.5214000000001,1304.5214000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27786,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",598.37700000000007,545.38639999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27788,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",804.3854,723.41100000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27792,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1186.6322,1186.6322,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27808,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",640.05499999999995,581.70579999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",893.69539999999995,799.62220000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27814,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1401.5716,1401.5716,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27816,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",629.93319999999994,556.69899999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27818,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",925.25159999999994,820.46119999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1611.1523999999999,1611.1523999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27823,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1807.039,1807.039,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27824,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",603.14020000000005,578.72879999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1018.134,912.15279999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27826,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1574.2376000000002,1574.2376000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27827,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2056.5115999999998,2056.5115999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27828,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2425.6596,2425.6596,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27829,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1308.0937999999999,1308.0937999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",738.89139999999998,679.35140000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27831,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",765.68439999999998,765.68439999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1390.8543999999999,1390.8543999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",723.41100000000006,723.41100000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",909.77119999999991,909.77119999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27846,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1316.4294,1316.4294,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27848,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1433.1278,1433.1278,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",301.27239999999995,301.27239999999995,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27870,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1835.0228,1835.0228,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27871,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1267.6065999999998,1267.6065999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27880,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1595.672,1595.672,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27881,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1526.6056000000001,1526.6056000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27882,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1050.8809999999999,1050.8809999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR",2,29]
[27884,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1038.973,1038.973,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27886,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1162.2208000000001,1162.2208000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27888,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1155.6713999999999,1155.6713999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27889,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1131.8554000000001,1131.8554000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27892,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",972.8836,972.8836,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27893,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1132.4508000000001,1132.4508000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27894,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1469.4472000000001,1469.4472000000001,"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",317.34820000000002,172.07060000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",456.67179999999996,251.25879999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",697.80880000000002,464.41199999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1040.1637999999998,1040.1637999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",793.66819999999996,538.83699999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",431.06959999999998,381.65140000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",578.13340000000005,509.66240000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1018.7293999999999,676.37439999999992,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28022,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",902.03100000000006,598.97239999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28024,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",851.42200000000003,561.46219999999994,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",981.81459999999993,657.32159999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28039,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",890.12299999999993,621.59759999999994,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",820.46119999999996,820.46119999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28043,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",712.09840000000008,476.91539999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",889.52760000000001,635.29179999999997,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",768.66139999999996,509.06700000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",719.83859999999993,465.6028,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28054,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",679.35140000000001,427.49719999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",700.19039999999995,700.19039999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",957.40319999999986,657.32159999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28062,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1063.3843999999999,735.9144,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",938.94579999999996,627.55159999999989,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28072,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",908.58039999999994,594.80460000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",990.15019999999993,696.02260000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",988.36400000000003,649.58140000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28088,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",856.18520000000001,535.86,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28090,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.33,565.03459999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28092,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",783.54639999999995,498.34979999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1139.0001999999999,767.47059999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1126.4968000000001,1126.4968000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",703.76279999999997,703.76279999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28104,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",969.90659999999991,646.00900000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",772.23379999999997,772.23379999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",932.39639999999997,630.52859999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[28108,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",804.98079999999993,527.52440000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",853.20820000000003,534.66920000000005,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",881.78740000000005,582.30119999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",895.48159999999996,573.96559999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28113,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1083.0326,781.76020000000005,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1967.2015999999999,1530.7734,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1440.2726,1076.4831999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28118,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1115.1841999999999,769.2568,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28119,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",969.3112000000001,664.46640000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.8136,907.38959999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1090.1773999999998,799.62220000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28124,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",880.00119999999993,610.28499999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",724.00639999999999,454.88559999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1106.2531999999999,1106.2531999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1046.7131999999999,773.42460000000005,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.61540000000002,509.66240000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28153,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",752.5856,483.46479999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",757.34879999999998,487.63259999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28171,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",450.12239999999997,241.13699999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[28192,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",848.44499999999994,566.22540000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28193,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",962.76180000000011,667.4434,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",917.51139999999998,599.56780000000003,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1106.8486,784.14179999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[28208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",905.00799999999992,591.82759999999996,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1101.49,777.5924,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[28220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",832.96460000000002,557.2944,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",974.66980000000001,664.46640000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28225,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",768.06600000000003,484.06020000000007,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1157.4576,739.48680000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",803.79,521.57039999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28232,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",700.78579999999999,440.596,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28234,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",761.51659999999993,494.18200000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28238,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1243.1951999999999,894.88619999999992,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",821.65200000000004,536.45539999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1086.605,750.79939999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1326.5512000000001,972.28819999999985,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2216.6741999999999,1709.9887999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2563.7924000000003,2041.6265999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28264,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1612.9386,1227.1194,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",900.24479999999994,611.47579999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",707.93060000000003,457.86260000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",943.70899999999995,635.29179999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28285,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",994.91340000000002,704.95359999999994,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",814.50720000000001,540.6232,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1118.1612,797.24059999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28289,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1275.9422,841.89560000000006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28291,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1286.6594,882.97820000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28292,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1286.6594,882.38279999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2001.1394,1116.375,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28296,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1646.8763999999999,933.58719999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28297,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1913.6156000000001,1098.5129999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28298,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1547.4445999999998,921.0838,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28299,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1874.9145999999998,1077.674,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1187.8229999999999,1187.8229999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1314.0478000000001,1314.0478000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28304,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1531.9641999999999,1120.5427999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1220.57,1220.57,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1127.6876,741.27299999999991,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1466.4702,953.83079999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1057.4304000000002,707.93060000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28309,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1634.9684,1634.9684,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1005.6306000000001,659.70320000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",993.12720000000002,620.40679999999998,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",980.02840000000003,660.29859999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",887.7414,597.78159999999991,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1116.375,1116.375,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28322,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1456.3484000000001,1057.4304000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28340,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",469.17519999999996,434.642,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",849.63580000000002,759.13499999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1049.0948000000001,1049.0948000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2056.5115999999998,2056.5115999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2372.6689999999999,2372.6689999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",455.48099999999999,397.72719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",700.78579999999999,617.4298,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28436,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",931.80100000000004,931.80100000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1890.9904000000001,1890.9904000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28446,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",398.91800000000001,359.6216,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",551.34039999999993,489.41880000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28456,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",704.35820000000001,704.35820000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1168.1748,1168.1748,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",413.20760000000001,387.01,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28475,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",484.65560000000005,423.9248,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28476,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",732.34199999999998,732.34199999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1037.7821999999999,1037.7821999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",269.12079999999997,236.37380000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",336.99639999999999,279.24260000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",859.75759999999991,464.41199999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1205.0895999999998,906.19880000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",228.6336,227.44279999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",309.608,269.12079999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1054.4534000000001,746.03620000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",218.51179999999999,188.74179999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",615.04819999999995,332.82859999999999,"090",0.1,0.69,0.21,0,2,1,1,2,0,null,"R",null,null,2,29]
[28540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",366.17099999999999,328.06540000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",588.25520000000006,512.63939999999991,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1111.0164,659.70320000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1604.0076000000001,1215.2113999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",448.9316,373.31579999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",716.86159999999995,639.45960000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",718.64779999999996,718.64779999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1630.2051999999999,1272.9651999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",413.803,350.09519999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",650.17679999999996,576.94259999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",711.50299999999993,711.50299999999993,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1523.0331999999999,1523.0331999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",286.9828,201.84059999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",328.06540000000001,246.49559999999997,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28636,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",581.70579999999995,364.38479999999998,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R",null,null,2,29]
[28645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1198.5401999999999,885.35979999999995,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",232.8014,170.87980000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[28665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",275.67019999999997,228.6336,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28666,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",324.49299999999999,324.49299999999999,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R",null,null,2,29]
[28675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1071.1245999999999,759.13499999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2206.5524,2206.5524,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1716.5382,1716.5382,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1420.6243999999999,1420.6243999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1330.7190000000001,1330.7190000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28735,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1419.4336000000001,1419.4336000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28737,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1248.5537999999999,1248.5537999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1527.7963999999999,1127.0922,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1445.6312,1055.0488,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28755,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",935.96879999999999,612.07119999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1400.3807999999999,1029.4466,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",957.40319999999986,957.40319999999986,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1271.7744,1271.7744,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",765.08899999999994,765.08899999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",549.55420000000004,317.9436,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",538.83699999999999,308.41719999999998,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",662.08479999999997,356.04920000000004,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",515.02099999999996,291.74600000000004,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",551.34039999999993,327.46999999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",484.65560000000005,261.38059999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",551.93579999999997,314.37119999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",541.81399999999996,304.84480000000002,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",592.423,341.75960000000003,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29049,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",185.76480000000001,126.2248,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",419.16160000000002,250.06800000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29058,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",229.22900000000001,169.68899999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",181.0016,124.43859999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",164.3304,114.9122,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",179.8108,122.6524,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",144.08679999999998,90.500799999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",154.20859999999999,75.020399999999995,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",124.43859999999999,73.829599999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",145.27760000000001,89.9054,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",77.402000000000001,52.990600000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",99.431799999999996,63.112400000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.135399999999997,33.342400000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",55.967599999999997,32.747,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.181400000000004,34.533199999999994,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.776800000000001,35.723999999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",464.41199999999998,288.17359999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",512.04399999999998,322.1114,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",251.85420000000002,180.40619999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",263.76220000000001,192.3142,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",300.08159999999998,186.36019999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",231.01519999999999,158.37640000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",148.85,106.5766,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",139.3236,98.241,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",213.74859999999998,146.4684,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",78.592799999999997,50.013599999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",235.18300000000002,176.8338,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,"Y-CM",2,29]
[29505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",166.11660000000001,94.668599999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",133.36960000000002,89.31,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",64.898600000000002,32.747,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",55.372199999999999,32.747,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",51.799799999999998,30.960799999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.128599999999999,19.648199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",117.8892,46.441200000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29581,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",169.09359999999998,48.227400000000003,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29584,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",155.9948,28.5792,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",116.10299999999999,58.944600000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",115.5076,80.379000000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29710,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",225.6566,147.06380000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",160.75800000000001,78.592799999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",117.8892,79.783600000000007,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",181.59699999999998,123.24779999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,"Y-CM",2,29]
[29799,null,{"$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]
[29804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1093.1543999999999,1093.1543999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[29826,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",306.03559999999999,306.03559999999999,"000",0,0,0,0,0,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29845,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1081.8418000000001,1081.8418000000001,"090",0.1,0.69,0.21,0,3,1,2,1,0,29840,"R",null,"Y-UR",2,29]
[29856,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1805.8481999999999,1805.8481999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[29875,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",915.12979999999993,915.12979999999993,"090",0.1,0.69,0.21,0,3,1,0,0,0,29870,"R",null,"Y-UR",2,29]
[29879,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1212.8298,1212.8298,"090",0.1,0.69,0.21,0,3,1,0,0,0,29870,"R",null,"Y-UR",2,29]
[29886,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1169.3656000000001,1169.3656000000001,"090",0.1,0.69,0.21,0,3,1,1,0,0,29870,"R",null,"Y-UR",2,29]
[29900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",936.56420000000003,936.56420000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[29914,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.69,0.21,0,3,1,2,1,0,29860,"X",null,"Y-UR",2,29]
[30120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"X",null,null,2,29]
[30320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",922.87,922.87,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R",null,null,2,29]
[30460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,2,2,0,null,"X",null,null,2,29]
[30630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1260.4618,1260.4618,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R",null,null,2,29]
[30901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",297.1046,100.62259999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[30999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[31081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2179.7593999999999,2179.7593999999999,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,29]
[31201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1493.2631999999999,1493.2631999999999,"090",0.1,0.76,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[31241,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,1,0,0,0,31231,"X",null,null,2,29]
[31291,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2205.9569999999999,2205.9569999999999,"010",0.1,0.8,0.1,0,3,1,0,0,0,31231,"R",null,null,2,29]
[31298,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6108.8039999999992,460.24420000000003,"000",0,0,0,0,3,1,0,0,0,31231,"R",null,"Y-CM",2,29]
[31395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[31511,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",393.55940000000004,242.32780000000002,"000",0,0,0,0,3,0,1,0,0,31505,"R",null,null,2,29]
[31515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",404.87199999999996,201.84059999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[31541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,31526,"X",null,null,2,29]
[31560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,0,0,0,31525,"X",null,null,2,29]
[31578,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",577.5379999999999,269.71620000000001,"000",0,0,0,0,3,0,0,0,0,31575,"R",null,null,2,29]
[31610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1774.8873999999998,1774.8873999999998,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[31623,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",510.85320000000002,232.20599999999999,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,null,2,29]
[31635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",538.83699999999999,307.8218,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,null,2,29]
[31645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",506.09,258.99899999999997,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,null,2,29]
[31648,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",345.92739999999998,345.92739999999998,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,null,2,29]
[31750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2520.3281999999999,2520.3281999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31781,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2600.7071999999998,2600.7071999999998,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1406.9302,1406.9302,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,29]
[32200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2008.8796,2008.8796,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32408,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1646.2809999999999,269.12079999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[32504,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[32552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",332.82859999999999,281.62420000000003,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[32555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",596.59079999999994,193.505,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[32650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1180.0827999999999,1180.0827999999999,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[32658,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1261.0572,1261.0572,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32669,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2344.6851999999999,2344.6851999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1586.741,1586.741,"090",0.1,0.76,0.14000000000000001,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[32906,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2871.0187999999998,2871.0187999999998,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1350.9626000000001,1350.9626000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33141,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,2,1,0,null,"X",null,"Y-CM",2,29]
[33206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",809.74399999999991,809.74399999999991,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,2,0,null,"R",null,"Y-CM",2,29]
[33220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",669.2296,669.2296,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",603.73559999999998,603.73559999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33241,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",385.22379999999998,385.22379999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33256,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3349.125,3349.125,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33267,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1821.924,1821.924,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7061.4439999999995,7061.4439999999995,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3246.1208000000001,3246.1208000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33362,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,2,1,null,"X",null,null,2,29]
[33412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5438.3836000000001,5438.3836000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3517.6232,3517.6232,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4151.1287999999995,4151.1287999999995,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33476,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2663.8196000000003,2663.8196000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33506,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3553.9425999999999,3553.9425999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33519,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",935.37340000000006,935.37340000000006,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4246.3927999999996,4246.3927999999996,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5306.8001999999997,5306.8001999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2846.6073999999999,2846.6073999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3049.0434,3049.0434,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33697,null,{"$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]
[33735,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33766,null,{"$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]
[33781,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33803,null,{"$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]
[33820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X",null,null,2,29]
[33880,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3077.6225999999997,3077.6225999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,2,2,2,0,null,"R",null,null,2,29]
[33884,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",669.82500000000005,669.82500000000005,"000",0,0,0,0,0,0,2,2,0,null,"R",null,null,2,29]
[33910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4576.8398000000007,4576.8398000000007,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33925,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[33946,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",535.26459999999997,535.26459999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33954,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",819.2704,819.2704,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[33968,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",58.349199999999996,58.349199999999996,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33971,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1241.4090000000001,1241.4090000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33988,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1333.6959999999999,1333.6959999999999,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM",2,29]
[33991,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",782.35559999999998,782.35559999999998,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[34203,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1632.5868,1632.5868,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[34502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2673.346,2673.346,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[34708,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3102.6293999999998,3102.6293999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[34715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",511.4486,511.4486,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-UR",2,29]
[34834,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",220.298,220.298,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-CM",2,29]
[34842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,2,2,0,null,"N",null,null,2,29]
[35082,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3709.3419999999996,3709.3419999999996,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3215.7554,3215.7554,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35180,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1374.1831999999999,1374.1831999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1684.3865999999998,1684.3865999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35304,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2182.7363999999998,2182.7363999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2604.2796000000003,2604.2796000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1678.4326000000001,1678.4326000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35523,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2179.7593999999999,2179.7593999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3327.6905999999999,3327.6905999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35572,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",586.46899999999994,586.46899999999994,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[35587,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2344.0897999999997,2344.0897999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3021.0596,3021.0596,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35654,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2340.5174000000002,2340.5174000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35683,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",694.83179999999993,694.83179999999993,"000",0,0,0,0,0,0,0,1,0,null,"R",null,"Y-CM",2,29]
[35691,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1624.8465999999999,1624.8465999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35879,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1587.3363999999999,1587.3363999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35884,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2119.0286000000001,2119.0286000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[36160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1069.9338,214.93939999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36216,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2013.0474000000002,469.17519999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1571.2606000000001,434.04660000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[36262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"X",null,null,2,29]
[36425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",70.257199999999997,70.257199999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2517.9465999999998,206.60380000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[36482,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3208.0152000000003,309.608,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[36510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[36568,null,{"$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]
[36571,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2406.6068,555.50819999999999,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[36589,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",301.86779999999999,244.70940000000002,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[36597,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",207.19919999999999,107.172,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36819,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1264.0342000000001,1264.0342000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[36831,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1069.3384000000001,1069.3384000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[36904,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3449.7475999999997,640.65039999999999,"000",0,0,0,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[36907,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1119.9474,254.23579999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[37192,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2409.5837999999999,585.87360000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[37197,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2969.8552,520.37959999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[37222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1157.4576,317.34820000000002,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37229,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17139.184400000002,1193.1815999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37242,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",13734.091799999998,825.81979999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[37249,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",830.58299999999997,251.25879999999998,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR",2,29]
[37616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1948.7441999999999,1948.7441999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[37619,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3048.4480000000003,3048.4480000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[38100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2046.9852000000001,2046.9852000000001,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,null,2,29]
[38115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2291.6946000000003,2291.6946000000003,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,null,2,29]
[38207,null,{"$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]
[38230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",360.81239999999997,360.81239999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[38500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",620.40679999999998,460.83960000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[38531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",807.36239999999998,807.36239999999998,"090",0.11,0.73,0.16,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[38720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2423.8733999999999,2423.8733999999999,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[38745,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1581.3824,1581.3824,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[39401,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",538.24159999999995,538.24159999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[39501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1511.7206000000001,1511.7206000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[39599,null,{"$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]
[40701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,2,2,0,0,null,"X",null,null,2,29]
[40812,null,{"$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]
[40843,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2226.7959999999998,1583.1686,"090",0.09,0.81,0.1,0,2,2,2,0,0,null,"R",null,"Y-CM",2,29]
[41008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",735.31899999999996,472.15219999999999,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41019,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,1,1,null,"X",null,null,2,29]
[41135,null,{"$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]
[41150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[41512,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1246.1722,1246.1722,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[41826,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[42106,null,{"$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]
[42210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X",null,null,2,29]
[42280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",334.01940000000002,200.6498,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[42440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",763.89819999999997,763.89819999999997,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[42505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1074.6970000000001,847.25419999999997,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[42660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",216.1302,160.1626,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[42815,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",998.48579999999993,998.48579999999993,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[42860,null,{"$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]
[42961,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.02,774.02,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[43030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",957.99860000000001,957.99860000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43113,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7540.741,7540.741,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[43192,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",306.63100000000003,306.63100000000003,"000",0,0,0,0,3,0,1,0,0,43191,"R",null,null,2,29]
[43195,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",334.01940000000002,334.01940000000002,"000",0,0,0,0,3,0,1,0,0,43191,"R",null,null,2,29]
[43204,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",241.13699999999997,241.13699999999997,"000",0,0,0,0,3,0,1,0,0,43200,"R",null,"Y-CM",2,29]
[43226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",732.93740000000003,231.61060000000001,"000",0,0,0,0,3,0,1,0,0,43200,"R",null,null,2,29]
[43236,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",761.51659999999993,245.3048,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",781.1647999999999,295.3184,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43253,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",466.19819999999999,466.19819999999999,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",209.58080000000001,209.58080000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[43285,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1203.3034,1203.3034,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[43288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6549.4,6549.4,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[43312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2760.2743999999998,2760.2743999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2327.4186,2327.4186,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43352,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1883.8456000000001,1883.8456000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"N",null,"Y-CM",2,29]
[43502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2712.0469999999996,2712.0469999999996,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",197.6728,197.6728,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43753,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",38.105600000000003,38.105600000000003,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[43756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",532.88299999999992,92.287000000000006,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[43772,null,{"$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]
[43842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,9,9,9,9,9,9,null,"X",null,null,2,29]
[43865,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3033.5630000000001,3033.5630000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1734.9956,1734.9956,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44127,null,{"$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]
[44132,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,29]
[44155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3680.7628,3680.7628,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44187,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1960.0568000000001,1960.0568000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44203,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",422.73399999999998,422.73399999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1502.7895999999998,1502.7895999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1134.8324,1134.8324,"090",0.09,0.81,0.1,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[44373,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",339.97339999999997,339.97339999999997,"000",0,0,0,0,3,0,1,0,0,44360,"R",null,"Y-CM",2,29]
[44389,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",776.99700000000007,305.4402,"000",0,0,0,0,3,0,1,0,0,44388,"R",null,"Y-CM",2,29]
[44392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",723.41100000000006,353.07219999999995,"000",0,0,0,0,3,0,1,0,0,44388,"R",null,"Y-CM",2,29]
[44615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1899.3259999999998,1899.3259999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44661,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2736.4584,2736.4584,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",296.50920000000002,296.50920000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[44955,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,2,1,0,null,"X",null,null,2,29]
[45100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",554.31740000000002,554.31740000000002,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4860.2501999999995,4860.2501999999995,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45172,null,{"$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]
[45315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",428.0926,188.1464,"000",0,0,0,0,3,0,1,0,0,45300,"R",null,"Y-CM",2,29]
[45342,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",303.654,303.654,"000",0,0,0,0,3,0,1,0,0,45330,"R",null,"Y-CM",2,29]
[45379,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",811.53020000000004,423.32940000000002,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM",2,29]
[45382,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1258.6756,459.64879999999999,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM",2,29]
[45398,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,45378,"X",null,null,2,29]
[45520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",312.58499999999998,73.829599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45905,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",310.79879999999997,310.79879999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[46040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1031.8281999999999,779.97399999999993,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46255,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",971.69280000000003,649.58140000000003,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",999.08120000000008,737.70060000000001,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,46600,"X",null,null,2,29]
[46611,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",425.11559999999997,144.68219999999999,"000",0,0,0,0,3,0,1,0,0,46600,"R",null,"Y-CM",2,29]
[46730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[46750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1355.7257999999999,1355.7257999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",407.25360000000001,281.62420000000003,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[46999,null,{"$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]
[47140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6335.0560000000005,6335.0560000000005,"090",0.09,0.81,0.1,0,2,0,2,1,2,null,"R",null,"Y-CM",2,29]
[47146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",573.37020000000007,573.37020000000007,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47382,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[47400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3814.1324,3814.1324,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2213.6972000000001,589.44600000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[47544,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1605.1984,273.28859999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR",2,29]
[47600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1911.2340000000002,1911.2340000000002,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[47711,null,{"$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]
[47801,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1998.7578000000001,1998.7578000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2108.3113999999996,2108.3113999999996,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48154,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5141.2789999999995,5141.2789999999995,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",187.55099999999999,187.55099999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[49010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1633.7776000000001,1633.7776000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[49020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2837.6763999999998,2837.6763999999998,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[49215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3918.9227999999994,3918.9227999999994,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[49324,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",691.85479999999995,691.85479999999995,"010",0.1,0.8,0.1,0,3,0,2,2,0,49320,"R",null,null,2,29]
[49418,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[49436,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1030.6373999999998,334.6148,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[49446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1535.5365999999999,256.61739999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[49465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",260.18979999999999,54.181400000000004,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[49557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1297.972,1297.972,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49593,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1013.3707999999999,1013.3707999999999,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[49616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1517.6745999999998,1517.6745999999998,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[49651,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1021.1109999999999,1021.1109999999999,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,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",1749.2851999999998,1749.2851999999998,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50236,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2601.8980000000001,2601.8980000000001,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4072.6621604148481,4072.6621604148481,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,29]
[50387,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1070.5291999999999,145.87300000000002,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[50391,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",225.6566,172.07060000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[50500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2227.9868000000001,2227.9868000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[50543,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2646.5530000000003,2646.5530000000003,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50562,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.08,0.83,0.09,0,2,0,2,1,0,null,"X",null,null,2,29]
[50590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1355.7257999999999,1025.8742,"090",0.08,0.83,0.09,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[50686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",263.76220000000001,157.18559999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[50705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3552.7518,309.01260000000002,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM",2,29]
[50780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1975.5372,1975.5372,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50785,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2159.5158000000001,2159.5158000000001,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50948,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2258.3521999999998,2258.3521999999998,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50953,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",722.81560000000002,574.56100000000004,"000",0,0,0,0,3,1,0,0,0,50951,"R",null,"Y-CM",2,29]
[51045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",903.81719999999996,903.81719999999996,"090",0.08,0.83,0.09,0,2,0,2,0,0,null,"R",null,null,2,29]
[51102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",446.55,255.42660000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[51585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.08,0.83,0.09,0,2,2,2,1,0,null,"X",null,null,2,29]
[51610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",242.32780000000002,114.9122,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[51725,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",135.1558,135.1558,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51726,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",150.04079999999999,150.04079999999999,"000",0,0,0,1,2,0,1,0,0,null,"R",null,null,2,29]
[51784,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",118.4846,118.4846,"000",0,0,0,1,2,0,1,0,0,null,"R",null,null,2,29]
[51785,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",827.01060000000007,827.01060000000007,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1257.4848,1257.4848,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[51920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1367.0384000000001,1367.0384000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[52010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",717.45699999999999,291.74600000000004,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,52000,"X",null,null,2,29]
[52287,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",729.36500000000001,298.89079999999996,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",510.25780000000003,510.25780000000003,"000",0,0,0,0,3,2,0,0,0,52000,"R",null,"Y-CM",2,29]
[52345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",692.4502,692.4502,"000",0,0,0,0,3,1,0,0,0,52351,"R",null,null,2,29]
[52352,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",622.78840000000002,622.78840000000002,"000",0,0,0,0,3,1,1,0,0,52351,"R",null,"Y-CM",2,29]
[52630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",731.74659999999994,731.74659999999994,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[53010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",538.83699999999999,538.83699999999999,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,null,2,29]
[53235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1137.8093999999999,1137.8093999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1431.3416,1431.3416,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53444,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1417.0520000000001,1417.0520000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53448,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2269.6648,2269.6648,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",113.12599999999999,113.12599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[53660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",140.51439999999999,74.424999999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[54050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",269.12079999999997,197.07740000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[54105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",506.68539999999996,382.84219999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[54162,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[54231,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",261.38059999999996,206.00839999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[54308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[54322,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,0,2,0,0,null,"X",null,null,2,29]
[54405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1444.4404000000002,1444.4404000000002,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[54410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1545.0629999999999,1545.0629999999999,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[54435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",747.82240000000002,747.82240000000002,"090",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[54550,null,{"$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]
[54700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",383.43760000000003,383.43760000000003,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[54900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1431.9370000000001,1431.9370000000001,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[55175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",660.89400000000001,660.89400000000001,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[55300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,2,0,0,0,null,"X",null,null,2,29]
[55720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.12560000000008,812.12560000000008,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[55810,null,{"$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]
[55845,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,2,2,1,0,null,"X",null,null,2,29]
[55899,null,{"$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]
[56606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",70.852599999999995,52.395200000000003,"000",0,0,0,0,0,0,1,2,0,null,"R",null,"Y-CM",2,29]
[56634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"X",null,null,2,29]
[57020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",233.9922,141.70519999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[57107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2633.4541999999997,2633.4541999999997,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",138.13279999999997,82.165199999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[57200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",610.88040000000001,610.88040000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[57265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1578.4054000000001,1578.4054000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57291,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,2,0,0,null,"X",null,null,2,29]
[57335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[57425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1757.0254,1757.0254,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57511,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[57550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",792.47739999999999,792.47739999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[58150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1830.855,1830.855,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1678.4326000000001,1678.4326000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[58301,null,{"$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]
[58520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1451.5852,1451.5852,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"X",null,null,2,29]
[58563,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,0,2,0,58555,"X",null,null,2,29]
[58579,null,{"$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]
[58672,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,3,1,2,0,0,49320,"X",null,null,2,29]
[58679,null,{"$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]
[58770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1563.5204000000001,1563.5204000000001,"090",0.12,0.74,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[58951,null,{"$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]
[59000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",214.34399999999999,142.3006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[59025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",89.31,89.31,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1464.684,1464.684,"090",0.17,0.6,0.23,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[59200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",197.6728,77.997399999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[59426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1857.0526,1406.3348000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59514,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1597.4581999999998,1597.4581999999998,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[59620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1649.8534,1649.8534,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[59856,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",892.50459999999998,892.50459999999998,"090",0.17,0.6,0.23,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,null,2,29]
[60270,null,{"$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,"Y-CM",2,29]
[60540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1923.1419999999998,1923.1419999999998,"090",0.09,0.82,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[61000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,2,1,0,0,null,"X",null,null,2,29]
[61140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2278.5958000000001,2278.5958000000001,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,null,2,29]
[61154,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2295.8624,2295.8624,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,null,2,29]
[61305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3573.5907999999999,3573.5907999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2576.2958000000003,2576.2958000000003,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,null,2,29]
[61501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2046.9852000000001,2046.9852000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61526,null,{"$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]
[61543,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3868.9092000000001,3868.9092000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61556,null,{"$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]
[61580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4540.5204000000003,4540.5204000000003,"090",0.11,0.76,0.13,0,2,1,1,1,2,null,"R",null,"Y-CM",2,29]
[61581,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4996.0014000000001,4996.0014000000001,"090",0.11,0.76,0.13,0,2,1,1,2,2,null,"R",null,"Y-CM",2,29]
[61592,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5679.5205999999998,5679.5205999999998,"090",0.11,0.76,0.13,0,2,1,2,1,2,null,"R",null,"Y-CM",2,29]
[61613,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5874.8118000000004,5874.8118000000004,"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",7920.6062000000002,7920.6062000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2279.1912000000002,2279.1912000000002,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[61770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,0,1,1,0,null,"X",null,null,2,29]
[61860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,0,2,0,0,null,"X",null,null,2,29]
[61863,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,1,2,1,0,null,"X",null,null,2,29]
[62000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1862.4112,1862.4112,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[62145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2531.6408000000001,2531.6408000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[62164,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3739.7074000000002,3739.7074000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[62252,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",154.20859999999999,154.20859999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[62273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",311.39420000000001,202.43599999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[62291,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",604.92639999999994,260.78519999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[62325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",475.72460000000001,198.26820000000001,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",257.21280000000002,153.01779999999999,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",790.69119999999998,790.69119999999998,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[63012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2150.5847999999996,2150.5847999999996,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2479.8409999999999,2479.8409999999999,"090",0.11,0.76,0.13,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[63055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2904.9566,2904.9566,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2729.3136,2729.3136,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",517.40260000000001,517.40260000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2988.9079999999999,2988.9079999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3335.4308000000001,3335.4308000000001,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[63278,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2856.7291999999998,2856.7291999999998,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3248.5024000000003,3248.5024000000003,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4276.7582000000002,4276.7582000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63685,null,{"$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,"Y-UR",2,29]
[63709,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2010.6658000000002,2010.6658000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[64418,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",160.75800000000001,99.431799999999996,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[64451,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",429.28339999999997,146.4684,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[64480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",251.25879999999998,109.5536,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR",2,29]
[64487,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",410.23059999999998,111.93519999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4837.625,712.09840000000008,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[64566,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,"Y-CM",2,29]
[64595,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",434.04660000000001,232.20599999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",248.87719999999999,193.505,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64636,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",459.05340000000001,105.3858,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR",2,29]
[64702,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",950.85379999999998,950.85379999999998,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64718,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1114.5888,1114.5888,"090",0.11,0.76,0.13,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[64726,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",494.18200000000002,494.18200000000002,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64771,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1060.4073999999998,1060.4073999999998,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[64776,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",731.1511999999999,731.1511999999999,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R",null,null,2,29]
[64804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2145.2262000000001,2145.2262000000001,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[64831,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1275.3468,1275.3468,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,null,2,29]
[64862,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2475.0778,2475.0778,"090",0.11,0.76,0.13,0,2,1,2,0,0,null,"R",null,null,2,29]
[64892,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1900.5168000000001,1900.5168000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64902,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1216.9976000000001,1216.9976000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[64910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1390.8543999999999,1390.8543999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[65112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2784.0904,2784.0904,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[65155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1795.7264,1795.7264,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1088.9866,837.7278,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[65420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1007.4168000000001,695.42719999999997,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65757,null,{"$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]
[65775,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1051.4764,1051.4764,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65855,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",450.12239999999997,372.125,"010",0.1,0.8,0.1,0,2,1,1,1,1,null,"R",null,null,2,29]
[65870,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1086.605,1086.605,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1799.2987999999998,1799.2987999999998,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66183,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,1,2,0,0,null,"X",null,null,2,29]
[66680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",953.23540000000003,953.23540000000003,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66761,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",553.72199999999998,430.4742,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[66940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1425.3876,1425.3876,"090",0.1,0.7,0.2,0,2,1,0,1,0,null,"R",null,null,2,29]
[66988,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","090",0.1,0.7,0.2,0,2,1,0,1,1,null,"N",null,"Y-CM",2,29]
[67031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",714.48,645.41359999999997,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1874.9145999999998,1874.9145999999998,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",943.11360000000002,907.38959999999997,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",541.21860000000004,461.435,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[67316,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1289.6364000000001,1289.6364000000001,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[67340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",522.16579999999999,522.16579999999999,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[67430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2566.7694000000001,2566.7694000000001,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R",null,null,2,29]
[67550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2013.0474000000002,2013.0474000000002,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[67820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.128599999999999,39.891800000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[67835,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",803.79,803.79,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[67914,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",915.72520000000009,600.7586,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",579.32420000000002,367.36180000000002,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67999,null,{"$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]
[68100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",338.18719999999996,172.666,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[68340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1129.4738,725.79259999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[68440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",193.505,183.9786,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[68745,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1496.2402,1496.2402,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[68761,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",272.09780000000001,214.93939999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[69105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",276.26559999999995,116.69839999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,0,1,1,0,null,"X",null,null,2,29]
[69421,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",282.815,282.815,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69436,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",295.3184,295.3184,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69554,null,{"$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]
[69631,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1665.3337999999999,1665.3337999999999,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[69650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1496.8356000000001,1496.8356000000001,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[69676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1558.1618000000001,1558.1618000000001,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69726,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",879.4058,879.4058,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69729,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"X",null,null,2,29]
[69949,null,{"$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,2,26]
[69990,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",379.26979999999998,379.26979999999998,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,26]
[70110,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",60.730800000000002,60.730800000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70130,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",29.77,29.77,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70160,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",15.480399999999999,15.480399999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",91.096199999999996,91.096199999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",68.470999999999989,68.470999999999989,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",84.54679999999999,84.54679999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",65.494,65.494,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",160.75800000000001,160.75800000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.135399999999997,60.135399999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70371,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",130.39259999999999,130.39259999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70460,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",191.71880000000002,191.71880000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70480,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",110.7444,110.7444,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70487,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",97.05019999999999,97.05019999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70488,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",109.5536,109.5536,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70496,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",150.63619999999997,150.63619999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70540,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",115.5076,115.5076,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70544,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",425.11559999999997,425.11559999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70548,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",485.25100000000003,485.25100000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",626.95619999999997,626.95619999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[71045,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",33.342400000000005,33.342400000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71046,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",44.655000000000001,44.655000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71110,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",25.006799999999998,25.006799999999998,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[71120,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",17.266599999999997,17.266599999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71130,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",19.052800000000001,19.052800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71271,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,4,0,0,0,0,null,"X",null,null,2,26]
[71552,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",194.10039999999998,194.10039999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",75.020399999999995,75.020399999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72072,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",74.424999999999997,74.424999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72074,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",83.951399999999992,83.951399999999992,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72084,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",152.42240000000001,152.42240000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72110,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",75.020399999999995,75.020399999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72114,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",91.096199999999996,91.096199999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72127,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",278.6472,278.6472,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72131,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",166.71199999999999,166.71199999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72133,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",109.5536,109.5536,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72147,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",153.61320000000001,153.61320000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",631.12400000000002,631.12400000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",52.990600000000001,52.990600000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72191,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",600.7586,600.7586,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72192,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",259.59440000000001,259.59440000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72196,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",531.09680000000003,531.09680000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",74.424999999999997,74.424999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72240,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",136.3466,136.3466,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72285,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",141.70519999999999,141.70519999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[73000,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",14.885,14.885,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73040,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",48.822799999999994,48.822799999999994,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73050,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",16.671200000000002,16.671200000000002,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[73090,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",55.372199999999999,55.372199999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73092,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[73115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",258.99899999999997,258.99899999999997,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",317.34820000000002,317.34820000000002,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73218,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",605.52179999999998,605.52179999999998,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73220,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",631.71939999999995,631.71939999999995,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73225,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",529.90600000000006,529.90600000000006,"000",0,0,0,1,4,0,9,0,0,null,"R",null,null,2,26]
[73501,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",45.845799999999997,45.845799999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73522,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",25.6022,25.6022,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73525,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",198.86359999999999,198.86359999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73552,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",16.075800000000001,16.075800000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73565,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",15.480399999999999,15.480399999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[73600,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",14.885,14.885,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",53.585999999999999,53.585999999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.4496,252.4496,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",326.87459999999999,326.87459999999999,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73706,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",475.72460000000001,475.72460000000001,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73722,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",139.91900000000001,139.91900000000001,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73723,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",582.89659999999992,582.89659999999992,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[74021,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",58.349199999999996,58.349199999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74170,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",400.10879999999997,400.10879999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74175,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",155.39939999999999,155.39939999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74181,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",125.03400000000001,125.03400000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74185,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",666.84799999999996,666.84799999999996,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74190,null,{"$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]
[74235,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",236.37380000000002,236.37380000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74251,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",715.07539999999995,715.07539999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",294.72300000000001,294.72300000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74283,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",304.24940000000004,304.24940000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74328,"TC",{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",50.013599999999997,50.013599999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74340,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",46.441200000000002,46.441200000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",297.1046,297.1046,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74415,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",42.273399999999995,42.273399999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74440,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.5562,31.5562,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",200.6498,200.6498,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74712,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,4,0,0,0,0,null,"X",null,null,2,26]
[74775,null,{"$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]
[75559,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",487.63259999999997,487.63259999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75561,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",497.15899999999999,497.15899999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75572,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",293.53219999999999,293.53219999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75600,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",41.677999999999997,41.677999999999997,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75635,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",202.43599999999998,202.43599999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[75716,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",300.67699999999996,300.67699999999996,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75736,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",267.93,267.93,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",303.654,303.654,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75801,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75803,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,2,0,0,0,null,"N",null,null,2,26]
[75810,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75822,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",125.62939999999999,125.62939999999999,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75833,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",150.04079999999999,150.04079999999999,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75842,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",129.20179999999999,129.20179999999999,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75880,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",60.730800000000002,60.730800000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75891,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",93.477800000000002,93.477800000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75898,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",442.38219999999995,442.38219999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75959,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75970,null,{"$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]
[76010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76098,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",51.799799999999998,51.799799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1743.3312000000001,1743.3312000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[76390,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",123.724368,123.724368,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-CM",2,26]
[76497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[76498,null,{"$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-UR",2,26]
[76512,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",55.372199999999999,55.372199999999999,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76513,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",82.760599999999997,82.760599999999997,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76519,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",71.447999999999993,71.447999999999993,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2,26]
[76604,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",56.562999999999995,56.562999999999995,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76705,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",116.10299999999999,116.10299999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76776,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",217.321,217.321,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76801,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",85.142199999999988,85.142199999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76802,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",41.082599999999999,41.082599999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76814,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",139.3236,139.3236,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76815,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.61320000000001,153.61320000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76818,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",219.70259999999999,219.70259999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76821,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",167.3074,167.3074,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76828,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",91.691599999999994,91.691599999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76831,"TC",{"$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]
[76872,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",325.68379999999996,325.68379999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76873,"TC",{"$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]
[76932,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[76936,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",320.3252,320.3252,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76942,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",54.181400000000004,54.181400000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76946,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",27.983799999999999,27.983799999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76977,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",8.3356000000000012,8.3356000000000012,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76979,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",73.234200000000001,73.234200000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76998,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",107.76739999999999,107.76739999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76999,"TC",{"$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]
[77013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[77014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",227.44279999999998,227.44279999999998,"000",0,0,0,1,0,0,9,0,0,null,"R",null,"Y-CM",2,26]
[77048,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",485.25100000000003,485.25100000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[77049,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",481.08319999999998,481.08319999999998,"000",0,0,0,1,4,2,0,0,0,null,"R",null,"Y-UR",2,26]
[77062,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,9,0,0,null,"X",null,"Y-CM",2,26]
[77065,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",167.90279999999998,167.90279999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",85.142199999999988,85.142199999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77074,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",122.6524,122.6524,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77080,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",54.776800000000001,54.776800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77081,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",41.677999999999997,41.677999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",195.88659999999999,195.88659999999999,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77280,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",445.35920000000004,445.35920000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",896.077,896.077,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77300,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",63.112400000000001,63.112400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77316,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",327.46999999999997,327.46999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77317,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",431.66500000000002,431.66500000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77333,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",72.043399999999991,72.043399999999991,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77334,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",109.5536,109.5536,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77402,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77417,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.197600000000001,26.197600000000001,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77470,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",194.69579999999999,194.69579999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77525,null,{"$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]
[77615,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",175.643,175.643,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77761,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",782.35559999999998,782.35559999999998,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77768,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77770,null,{"$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]
[77790,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM",2,26]
[77799,26,{"$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]
[78014,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",42.273399999999995,42.273399999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78018,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",483.46479999999997,483.46479999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78072,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",642.43659999999988,642.43659999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78099,"TC",{"$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]
[78110,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",13.6942,13.6942,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78111,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",16.075800000000001,16.075800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78185,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",301.86779999999999,301.86779999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78191,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",233.39679999999998,233.39679999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78201,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",304.84480000000002,304.84480000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78216,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",243.51859999999999,243.51859999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78231,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",195.88659999999999,195.88659999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78258,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",320.92059999999998,320.92059999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78265,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",612.6665999999999,612.6665999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78266,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",701.97659999999996,701.97659999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78299,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report ","By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",403.68119999999999,403.68119999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78306,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",452.50399999999996,452.50399999999996,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,26]
[78414,"TC",{"$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]
[78430,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",134.56039999999999,134.56039999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78433,null,{"$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-UR",2,26]
[78452,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",832.96460000000002,832.96460000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78453,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",518.59340000000009,518.59340000000009,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78459,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",3147.5847171225605,3147.5847171225605,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR",2,26]
[78466,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",270.90699999999998,270.90699999999998,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78469,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",77.402000000000001,77.402000000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78491,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3285.9314808914883,3285.9314808914883,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR",2,26]
[78496,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",42.273399999999995,42.273399999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78579,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",41.677999999999997,41.677999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78598,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",70.257199999999997,70.257199999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",386.41460000000001,386.41460000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78609,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,9,9,9,9,9,null,"N",null,"Y-CM",2,26]
[78610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",314.96659999999997,314.96659999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78635,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",547.17259999999999,547.17259999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78699,"TC",{"$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]
[78708,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",327.46999999999997,327.46999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78725,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",182.78779999999998,182.78779999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78799,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78801,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",61.3262,61.3262,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78811,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78812,null,{"$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]
[78814,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78831,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",151.23159999999999,151.23159999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79005,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",151.827,151.827,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79200,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",142.3006,142.3006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79445,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",196.482,196.482,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[80051,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.9541999999999984,9.9541999999999984,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.769399999999997,54.769399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80158,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",25.631,25.631,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80167,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.468799999999998,26.468799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.468799999999998,26.468799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80194,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.731999999999999,20.731999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.226799999999997,19.226799999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",88.238799999999998,88.238799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80326,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80341,null,{"$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]
[80348,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80360,null,{"$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]
[80367,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80408,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",178.20999999999998,178.20999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80435,null,{"$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]
[81005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3.0813999999999999,3.0813999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81105,null,{"$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]
[81108,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81166,null,{"$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]
[81174,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81188,null,{"$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]
[81202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81209,null,{"$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]
[81224,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81231,null,{"$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]
[81234,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81246,null,{"$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]
[81253,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81267,null,{"$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]
[81276,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81286,null,{"$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]
[81298,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81305,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81320,null,{"$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]
[81327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81339,null,{"$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]
[81351,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81361,null,{"$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]
[81378,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",490.70939999999996,490.70939999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81401,null,{"$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]
[81404,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81417,null,{"$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]
[81427,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81441,null,{"$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",10214.06,10214.06,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC",2,23]
[81538,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81599,null,{"$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]
[82030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",36.635999999999996,36.635999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.813399999999998,23.813399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82143,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",13.276999999999999,13.276999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82164,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.731999999999999,20.731999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.2195999999999998,6.2195999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82308,null,{"$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]
[82331,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82387,null,{"$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]
[82415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.991399999999999,17.991399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.622199999999999,17.622199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.0138,19.0138,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82595,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.1873999999999985,9.1873999999999985,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82658,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",62.522599999999997,62.522599999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82679,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.428999999999995,35.428999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82696,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",37.260799999999996,37.260799999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82777,null,{"$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]
[82787,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.388399999999999,11.388399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82947,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5.5805999999999996,5.5805999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82962,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4.6575999999999995,4.6575999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.383599999999998,26.383599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[83020,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.5562,31.5562,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[83065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.78,12.78,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.7449999999999992,6.7449999999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83527,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.144399999999997,28.144399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.1873999999999985,9.1873999999999985,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83633,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",15.975,15.975,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.7837999999999994,9.7837999999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83775,null,{"$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]
[83857,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",15.2508,15.2508,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83919,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.358999999999998,23.358999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.6844000000000001,9.6844000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.458399999999997,23.458399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.7308000000000003,6.7308000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84138,null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.113800000000001,26.113800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84181,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.5562,31.5562,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[84203,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",13.8308,13.8308,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",43.991599999999998,43.991599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84285,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.798200000000001,35.798200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",72.817599999999999,72.817599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.1356,20.1356,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84484,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.7074,17.7074,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84577,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.855999999999998,23.855999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84586,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84999,null,{"$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]
[85007,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5.3959999999999999,5.3959999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",42.8688,42.8688,"000",0,0,0,8,0,0,0,0,0,null,"R",null,null,2,23]
[85170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.146000000000001,23.146000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85292,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.880599999999998,26.880599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",15.350199999999999,15.350199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85362,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.7837999999999994,9.7837999999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85385,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.533200000000001,20.533200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.2726000000000006,9.2726000000000006,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85536,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.7695999999999987,9.7695999999999987,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",24.835799999999995,24.835799999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85651,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.0633999999999988,6.0633999999999988,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86021,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.370999999999999,21.370999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[86140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.355599999999999,7.355599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",22.7058,22.7058,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.814999999999998,18.814999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86277,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[86318,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",25.687799999999999,25.687799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86325,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.5562,31.5562,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[86343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.693200000000001,17.693200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86353,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",69.622599999999991,69.622599999999991,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86381,null,{"$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]
[86409,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,23]
[86490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",149.44539999999998,149.44539999999998,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,23]
[86609,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.2896,18.2896,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",16.287400000000002,16.287400000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86644,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.433800000000002,20.433800000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86682,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.4742,18.4742,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86688,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.88,19.88,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.623800000000001,12.623800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86717,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.395,17.395,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",22.563800000000001,22.563800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86769,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",59.824600000000004,59.824600000000004,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86794,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.927,23.927,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.995799999999999,21.995799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",459.72499999999997,459.72499999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86835,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",458.60319999999996,458.60319999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86886,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.355599999999999,7.355599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86921,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[86965,null,{"$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]
[86977,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[87075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",13.4474,13.4474,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.4146000000000001,9.4146000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87149,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.471,28.471,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87153,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",163.81119999999999,163.81119999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87169,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.1201999999999988,6.1201999999999988,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87205,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.0633999999999988,6.0633999999999988,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87255,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",48.081199999999995,48.081199999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.0564,19.0564,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87290,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.0564,19.0564,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.0564,19.0564,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87380,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.071199999999997,26.071199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",34.165199999999999,34.165199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87428,null,{"$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,"L",null,"Y-CM",2,23]
[87480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.471,28.471,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",42.642600000000002,42.642600000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87503,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[87520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",44.332399999999993,44.332399999999993,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.36,82.36,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.471,28.471,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",38.169599999999996,38.169599999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.471,28.471,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[87651,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87803,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",22.72,22.72,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87880,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.4726,23.4726,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",365.57899999999995,365.57899999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[88028,null,{"$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]
[88037,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[88106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",131.58339999999998,131.58339999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",799.02679999999998,799.02679999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88140,null,{"$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]
[88160,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",45.845799999999997,45.845799999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88172,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",63.112400000000001,63.112400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88177,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.181400000000004,54.181400000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88199,null,{"$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,2,23]
[88230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",165.41579999999999,165.41579999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",245.90139999999997,245.90139999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.179600000000001,60.179600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88299,null,{"$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",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",66.68480000000001,66.68480000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88312,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",47.0366,47.0366,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88319,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",256.61739999999998,256.61739999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88331,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",78.592799999999997,78.592799999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88334,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",104.19499999999999,104.19499999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",162.54419999999999,162.54419999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88348,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",897.26779999999997,897.26779999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88355,26,{"$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,2,23]
[88361,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",528.11979999999994,528.11979999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88368,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88373,26,{"$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,2,23]
[88377,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88380,26,{"$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,2,23]
[88399,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,23]
[89050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.702399999999999,6.702399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[89251,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89280,null,{"$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]
[89321,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.111000000000001,17.111000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,16]
[89344,null,{"$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]
[90283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90288,null,{"$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]
[90393,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90473,null,{"$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,2,16]
[90632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",70.099999999999994,70.099999999999994,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90649,null,{"$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]
[90664,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,16]
[90676,null,{"$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]
[90689,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90694,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",71.680000000000007,71.680000000000007,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,17]
[90723,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,17]
[90740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",152.12,152.12,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,17]
[90832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",135.75119999999998,118.4846,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM",2,17]
[90840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",125.62939999999999,111.33980000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,17]
[90875,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",106.5766,105.3858,"000",0,0,0,9,9,9,9,9,9,null,"R",null,"Y-CM",2,17]
[90913,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",58.944600000000001,43.464199999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,6]
[90953,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[90956,null,{"$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]
[90993,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
[91010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",419.16160000000002,419.16160000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",272.69319999999999,272.69319999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91035,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",735.9144,735.9144,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91065,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",142.89599999999999,142.89599999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91117,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",244.11399999999998,244.11399999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[91132,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",807.95780000000002,807.95780000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91132,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",47.0366,47.0366,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91309,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
[91314,null,{"$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]
[92025,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",32.747,32.747,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",49.418199999999999,49.418199999999999,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2]
[92100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",160.1626,58.349199999999996,"000",0,0,0,0,0,2,0,0,0,null,"R",null,null,2]
[92136,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",54.776800000000001,54.776800000000001,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2]
[92228,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",29.77,29.77,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92228,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",24.411399999999997,24.411399999999997,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",161.94880000000001,161.94880000000001,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",204.8176,204.8176,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",72.638800000000003,72.638800000000003,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",186.9556,77.997399999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92354,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
[92499,"TC",{"$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]
[92521,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",244.70940000000002,244.70940000000002,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2]
[92524,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",201.24519999999998,201.24519999999998,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2]
[92541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",46.441200000000002,46.441200000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92542,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",52.990600000000001,52.990600000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92547,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.243600000000001,20.243600000000001,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,29]
[92550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",41.082599999999999,41.082599999999999,"000",0,0,0,7,0,2,0,0,0,null,"R",null,null,2,29]
[92568,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",27.983799999999999,27.388400000000001,"000",0,0,0,7,0,2,0,0,0,null,"R",null,null,2,29]
[92579,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.760599999999997,67.280199999999994,"000",0,0,0,7,0,2,0,0,0,null,"R",null,null,2]
[92592,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,26]
[92595,null,{"$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,2,26]
[92613,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,0,0,0,0,0,0,null,"B",null,"Y-CM",2,26]
[92616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",420.94780000000003,179.21539999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[92920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,26]
[92925,null,{"$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]
[92960,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",285.79199999999997,194.10039999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[92977,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",99.431799999999996,99.431799999999996,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.792999999999999,26.792999999999999,"000",0,0,0,4,6,0,0,0,0,null,"R",null,null,2,26]
[93015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",130.988,130.988,"000",0,0,0,4,6,0,0,0,0,null,"R",null,null,2,26]
[93225,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.128599999999999,35.128599999999999,"000",0,0,0,3,6,0,0,0,0,null,"R",null,null,2,26]
[93228,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",45.845799999999997,45.845799999999997,"000",0,0,0,2,0,0,0,0,0,null,"R",null,null,2,26]
[93264,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,26]
[93271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",280.43340000000001,280.43340000000001,"000",0,0,0,3,6,0,0,0,0,null,"R",null,null,2,26]
[93281,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",75.020399999999995,75.020399999999995,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93283,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",83.355999999999995,83.355999999999995,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93287,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",39.891800000000003,39.891800000000003,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93288,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",36.9148,36.9148,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93292,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",95.859400000000008,95.859400000000008,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93296,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",42.8688,42.8688,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93308,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",141.70519999999999,141.70519999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93312,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",252.4496,252.4496,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93317,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",156.59019999999998,156.59019999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[93320,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.5562,31.5562,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[93351,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",147.6592,147.6592,"000",0,0,0,1,6,0,9,9,9,null,"R",null,null,2,26]
[93452,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1701.0578,1701.0578,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93454,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1707.0118,1707.0118,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93456,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",537.64619999999991,537.64619999999991,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",363.19399999999996,363.19399999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93464,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",254.23579999999998,254.23579999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93569,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,26]
[93573,null,{"$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]
[93593,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,2,0,0,0,0,null,"X",null,null,2,26]
[93596,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,2,0,0,0,0,null,"X",null,null,2,26]
[93598,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[93602,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",200.6498,200.6498,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93615,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",66.089400000000012,66.089400000000012,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93616,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",104.19499999999999,104.19499999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93621,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",144.08679999999998,144.08679999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93624,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,2,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93642,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",598.97239999999999,598.97239999999999,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93653,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1468.8518000000001,1468.8518000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-UR",2,26]
[93701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",50.608999999999995,50.608999999999995,"000",0,0,0,3,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93724,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",89.31,89.31,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93798,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",47.632000000000005,24.411399999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93799,"TC",{"$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]
[93886,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",514.42560000000003,514.42560000000003,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93893,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",752.5856,752.5856,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93924,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",299.4862,299.4862,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93926,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",231.61060000000001,231.61060000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93971,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",188.74179999999998,188.74179999999998,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93975,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",98.836399999999998,98.836399999999998,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93981,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",94.0732,94.0732,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93985,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",404.87199999999996,404.87199999999996,"000",0,0,0,1,6,2,0,0,0,null,"R",null,"Y-CM",2,26]
[93990,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",41.082599999999999,41.082599999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[94014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",103.0042,103.0042,"000",0,0,0,4,0,0,0,0,0,null,"R",null,null,2]
[94200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",27.983799999999999,27.983799999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94450,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",119.67539999999998,119.67539999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94621,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",285.19659999999999,285.19659999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",144.68219999999999,48.227400000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[94681,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",88.714600000000004,88.714600000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",90.500799999999998,90.500799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94727,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",60.730800000000002,60.730800000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94772,26,{"$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]
[95012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.723999999999997,35.723999999999997,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[95052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.908000000000001,11.908000000000001,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[95131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
[95147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",112.53059999999999,5.3586,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95249,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
[95708,null,{"$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]
[95715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95782,null,{"$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]
[95803,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",262.57139999999998,262.57139999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95806,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",92.882400000000004,92.882400000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95811,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",984.7915999999999,984.7915999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95813,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",153.01779999999999,153.01779999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",792.47739999999999,792.47739999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95829,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",2775.7547999999997,2775.7547999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",210.17619999999999,210.17619999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95865,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",279.24260000000004,279.24260000000004,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95867,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",126.82019999999999,126.82019999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95872,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",267.93,267.93,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95885,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",84.54679999999999,84.54679999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95887,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",66.68480000000001,66.68480000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95909,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",107.76739999999999,107.76739999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95911,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",234.58759999999998,234.58759999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95912,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",178.02460000000002,178.02460000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95923,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",151.827,151.827,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95925,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",50.608999999999995,50.608999999999995,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95929,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",140.51439999999999,140.51439999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95938,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",80.974400000000003,80.974400000000003,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95954,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",568.60700000000008,568.60700000000008,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95961,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",285.19659999999999,285.19659999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95965,null,{"$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]
[95966,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95981,null,{"$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]
[95999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
[96112,null,{"$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]
[96138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",64.898600000000002,64.898600000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,25]
[96161,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,5,9,9,9,9,9,null,"X",null,null,2,25]
[96366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",38.105600000000003,38.105600000000003,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,25]
[96371,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",107.76739999999999,107.76739999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,25]
[96375,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",29.174599999999998,29.174599999999998,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,25]
[96416,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",243.51859999999999,243.51859999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,25]
[96446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",360.81239999999997,43.464199999999998,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2,25]
[96900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",46.441200000000002,46.441200000000002,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2,25]
[96934,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",225.06119999999999,225.06119999999999,"000",0,0,0,4,0,0,0,0,0,null,"R",null,"Y-CM",2,10]
[97016,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.4344,21.4344,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,23]
[97110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.776800000000001,54.776800000000001,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,23]
[97139,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",29.315523672864003,29.315523672864003,"000",0,0,0,7,0,0,0,0,0,null,"F",null,null,2,25]
[97156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,25]
[97164,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",129.20179999999999,129.20179999999999,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,25]
[97171,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,25]
[97605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,0,0,0,0,0,0,null,"B",null,"Y-CM",2,10]
[97760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",91.096199999999996,91.096199999999996,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,10]
[98926,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.165199999999999,62.517000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[98967,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",43.464199999999998,39.296399999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[98977,null,{"$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]
[99026,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99058,null,{"$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,"B",null,null,2,10]
[99080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",52.132423543199998,52.132423543199998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,10]
[99157,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",110.7444,110.7444,"000",0,0,0,9,9,9,9,9,9,null,"R",null,"Y-CM",2,10]
[99183,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",188.74179999999998,188.74179999999998,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,10]
[99211,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",43.464199999999998,16.075800000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",285.79199999999997,285.79199999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",384.03300000000002,325.08839999999998,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",214.34399999999999,214.34399999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",239.9462,239.9462,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99316,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",236.37380000000002,236.37380000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",73.829599999999999,72.043399999999991,"000",0,0,0,9,9,9,9,9,9,null,"R",null,"Y-CM",2,10]
[99379,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,10]
[99394,null,{"$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]
[99411,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[99422,null,{"$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]
[99425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99452,null,{"$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]
[99455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99468,null,{"$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]
[99476,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99491,null,{"$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]
[99503,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[99511,null,{"$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]
[99601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",178.90523761968004,178.90523761968004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0010E",null,{"$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]
["0011U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0016M",null,{"$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]
["0021U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0071T",null,{"$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]
["0076T","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2]
["0093U",null,{"$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]
["0095T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0106U",null,{"$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]
["0111U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0116U",null,{"$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]
["0123U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0134A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",40,40,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["0140U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0151U",null,{"$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]
["0154A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0175T",null,{"$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]
["0205U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0209T",null,{"$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]
["0212U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0218U",null,{"$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]
["0222T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-UR",2]
["0232U",null,{"$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]
["0234U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0266T",null,{"$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]
["0275T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0292U",null,{"$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]
["0295U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0304R",null,{"$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]
["0332T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0352T",null,{"$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]
["0355U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0380R",null,{"$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]
["0389R",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.52281496752,12.52281496752,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0397T",null,{"$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]
["0407A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2]
["0414A",null,{"$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]
["0419T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,21]
["0430T",null,{"$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]
["0433T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0448T",null,{"$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]
["0469T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0484T",null,{"$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]
["0500T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0510T",null,{"$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,"Y-CM",2]
["0516F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0522T",null,{"$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]
["0527T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0536T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2]
["0539T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0545T",null,{"$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]
["0556F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0566C",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["0571T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0581F",null,{"$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,"T",null,null,2]
["0584T",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]
["0625T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
["0672T",null,{"$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]
["0674T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-UR",2]
["0681T",null,{"$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,"Y-UR",2]
["0693T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0707T",null,{"$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]
["0738T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0750T",null,{"$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]
["0753T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
["0769T",null,{"$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]
["0771T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0778T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,2,0,0,0,null,"X",null,null,2]
["0810V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",10.393384757184004,10.393384757184004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,12]
["0843V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",8.8597536730559998,8.8597536730559998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0894V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,"Y-CM",2]
["1007F",null,{"$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,"T",null,null,2]
["1011F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1036F",null,{"$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,"T",null,null,2]
["1038M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Revw job offer/analysis for empl,per job",58.928946908832003,58.928946908832003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["1046M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Provider travel per mile, round trip exc",5.8145581391040002,5.8145581391040002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,22]
["1066M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Provider review of video materials with report","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,27]
["1077M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Opioid req for subacute pain w/doc",68.009366924928003,68.009366924928003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["1091F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1116F",null,{"$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,"T",null,null,2]
["1123M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ime - communication issues",237.80331000000001,237.80331000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,12]
["1130M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ime - terminated examination",421.25908200000009,421.25908200000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1136F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1146M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"IME Forensic exam ",421.26,421.26,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1154M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cervical motion template studies",73.724625209664012,73.724625209664012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["1175F",null,{"$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,"T",null,null,2]
["1192M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Impairment rating by a/p, complex",890.13,890.13,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,12]
["1223M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nurse case mgmt travel/wait per unit",6.42,6.42,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["1245M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Utilization review physical medicine","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1291M",null,{"$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,"Y-ONC",2]
["1303W",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["1460F",null,{"$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,"T",null,null,2]
["1503F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1728M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"PGAP Coach Travel Time",8.4294543041280008,8.4252000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,22]
["2015M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pain clinic follow-up services: not face-to face/hr",1.3791646440000005,1.3791646440000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,34]
["2028F",null,{"$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,"T",null,null,2]
["2044F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3008F",null,{"$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,"T",null,null,2]
["3015F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3022F",null,{"$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,"T",null,null,2]
["3048F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3056F",null,{"$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,"T",null,null,2]
["3080F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3096F",null,{"$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,"T",null,null,2]
["3118F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3170F",null,{"$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,"T",null,null,2]
["3215F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3265F",null,{"$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,"T",null,null,2]
["3280F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3291F",null,{"$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,"T",null,null,2]
["3321F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3344F",null,{"$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,"T",null,null,2]
["3370F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3395F",null,{"$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,"T",null,null,2]
["3472F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3490F",null,{"$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,"T",null,null,2]
["3510F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3517F",null,{"$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,"T",null,null,2]
["3751F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3763F",null,{"$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,"T",null,null,2]
["4005F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4025F",null,{"$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,"T",null,null,2]
["4042F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4045F",null,{"$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,"T",null,null,2]
["4058F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4073F",null,{"$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,"T",null,null,2]
["4100F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,18]
["4140F",null,{"$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,"T",null,null,2]
["4151F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4171F",null,{"$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,"T",null,null,2]
["4179F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4182F",null,{"$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,"T",null,null,2]
["4196F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4248F",null,{"$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,"T",null,null,2]
["4267F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4279F",null,{"$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,"T",null,null,2]
["4350F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,28]
["4551F",null,{"$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,"T",null,null,2]
["4558F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4561F",null,{"$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,"T",null,null,2]
["5092V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.520390018997677,28.520390018997677,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["6020F",null,{"$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,"T",null,null,2,28]
["6110F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["8882H",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",689.3048,689.3048,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["8901H",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",15.153179410512001,15.153179410512001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["9001F",null,{"$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,"T",null,null,2]
["9915M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"IND HYGIENIST OFFICE VISIT",222.00585804000002,222.00585804000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["9918M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electronic Provider Communication",51.823156319999995,49.101261840000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,10]
["A0100",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nonemergency transport taxi","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A0130",null,{"$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,2,28]
["A0392",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Als defibrillation supplies",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A0422",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ambulance 02 life sustaining",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A0435",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fixed wing air mileage",37.693285782803173,37.693285782803173,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A2008",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Theragenesis, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A2015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Phoenix wnd mtrx, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A2018",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Permeaderm c, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4218",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sterile saline or water",0.97579999999999989,0.97579999999999989,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4222",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Infusion supplies with pump",53.009399999999999,53.009399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,28]
["A4239",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-adju cgm supply allow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4248",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chlorhexidine antisept",0.1066,0.1066,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4264",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intratubal occlusion device","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4285",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replcmnt breast pump bottle","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4310",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Insert tray w/o bag/cath",10.4754,10.4754,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4313",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Catheter w/bag 3-way",23.276400000000002,23.276400000000002,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4336",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urethral insert",1.9481999999999999,1.9481999999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4340",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Indwelling catheter special",43.064399999999999,43.064399999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4357",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bedside drainage bag",13.168200000000001,13.168200000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4371",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Skin barrier powder per oz",4.8756000000000004,4.8756000000000004,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4379",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urinary plastic pouch w fcpl",20.369399999999999,20.369399999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4387",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ost clsd pouch w att st barr",3.0498000000000003,3.0498000000000003,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4400",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ostomy irrigation set",60.098400000000005,60.098400000000005,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4405",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nonpectin based ostomy paste",4.6307999999999998,4.6307999999999998,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4421",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ostomy supply misc",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4424",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ost pch drain w bar & filter",6.4565999999999999,6.4565999999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4436",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Irr supply sleev reus per mo",26.01,26.01,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4465",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-elastic extremity binder",36.793399999999998,36.793399999999998,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A4495",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Thigh length surg stocking",36.793399999999998,36.793399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4555",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ca tx e-stim electr/transduc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4575",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hyperbaric o2 chamber disps",814.7109999999999,814.7109999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4595",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tens suppl 2 lead per month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["A4618",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Breathing circuits",32.928905035008,32.928905035008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4623",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tracheostomy inner cannula",8.894400000000001,8.894400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4637",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repl tip cane/crutch/walker",3.138202882656,3.138202882656,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4653",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pd catheter anchor belt","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A4673",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ext line w easy lock connect",12.611599999999999,12.611599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4709",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Acid conc sol per gallon",57.818199999999997,57.818199999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4736",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Topical anesthetic, per gram","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A4750",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Art or venous blood tubing",78.843000000000004,78.843000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A4918",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Venous pressure clamp","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A4929",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tourniquet for dialysis, ea",1.0495999999999999,1.0495999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["A5073",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urinary pouch on barr w/flng",4.2534000000000001,4.2534000000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A5083",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Stoma absorptive cover",0.87719999999999998,0.87719999999999998,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A5501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic custom molded shoe",258.70260000000002,258.70260000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,28]
["A5506",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic shoe w/off set heel",43.921200000000006,43.921200000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,28]
["A6023",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Collagen dressing >48 sq in",258.15179999999998,258.15179999999998,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6154",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Wound pouch each",19.482000000000003,19.482000000000003,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6214",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Foam drg > 48 sq in w/border",13.963799999999999,13.963799999999999,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6217",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-sterile gauze>16<=48 sq",0.45100000000000001,0.45100000000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6236",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydrocolld drg > 48 in w/o b",36.964800000000004,36.964800000000004,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6239",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydrocolld drg > 48 in w/bdr",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6254",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Absorpt drg <=16 sq in w/bdr",1.6218000000000001,1.6218000000000001,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6258",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transparent film >16<=48 in",5.8446000000000007,5.8446000000000007,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6412",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Occlusive eye patch",0.63139999999999996,0.63139999999999996,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6446",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Conform band s w>=3\" <5\"/yd",0.53039999999999998,0.53039999999999998,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["A6460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Synthetic drsg <= 16 sq in","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A6502",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Compres burngarment chinstrp","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["A6534",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gc stocking thighlngth 30-40",106.6164,106.6164,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A6537",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gc stocking full lngth 30-40",89.355399999999989,89.355399999999989,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7003",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nebulizer administration set",5.2561999999999998,5.2561999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7007",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lg vol nebulizer disposable",5.7809999999999997,5.7809999999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7025",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replace chest compress vest","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["A7032",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replacement nasal cushion",60.269999999999996,60.269999999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7046",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repl water chamber, pap dev",61.499999999999993,61.499999999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7049",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Epap nasal valve","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["A7526",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tracheostomy tube collar",4.6002000000000001,4.6002000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A8001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hard protect helmet prefab",296.26235429040008,296.26235429040008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A9274",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ext amb insulin delivery sys",42.607199999999999,42.607199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["A9278",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"External receiver, cgm sys",1103.72,1103.72,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["A9503",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tc99m medronate","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9512",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tc99m pertechnetate","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-PHL",2,9]
["A9530",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"I131 iodide sol, rx","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9536",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tc99m depreotide","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-PHL",2,9]
["A9555",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rb82 rubidium","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9558",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Xe133 xenon 10mci","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9566",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tc99m fanolesomab","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,9]
["A9576",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj prohance multipack",1.43,1.43,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,9]
["A9590",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Iodine i-131 iobenguane 1mci",346.21,346.21,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,9]
["A9597",null,{"$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,2,9]
["A9800",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gallium locametz 1 millicuri","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["A9999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dme supply or accessory, nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["B4152",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ef calorie dense>/=1.5kcal",0.55080000000000007,0.55080000000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2]
["B4155",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ef incomplete/modular",1.0710000000000002,1.0710000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2]
["B4164",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Parenteral 50% dextrose solu",23.939399999999999,23.939399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2]
["B4193",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Parenteral sol 52-73 gm prot",323.52359999999999,323.52359999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2]
["B9006","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Parenteral infus pump statio",3554.1084000000001,3554.1084000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["C1714",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, trans atherectomy, dir",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1729",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, drainage",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1748",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endoscope, single, ugi","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["C1760",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Closure dev, vasc",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1763",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Conn tiss, non-human",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1770",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Imaging coil, mr, insertable",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1784",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ocular dev, intraop, det ret",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1814",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retinal tamp, silicone oil",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1825",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gen, neuro, carot sinus baro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C1877",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Stent, non-coat/cov w/o del",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1885",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, translumin angio laser",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1898",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lead, pmkr, other than trans",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C1982",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, pressure,valve-occlu","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2]
["C2618",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Probe/needle, cryo",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C2630",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, ep, cool-tip",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C2639",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Brachytx, non-stranded,i-125","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C5273",null,{"$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]
["C7506",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fusion of finger joints","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7513",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath/angio dialcir w/aplasty","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7525",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"L hrt gft ang w/ ivus or oct","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7528",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"R&l hrt angio w/flow resrv","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7535",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fem/pop revasc w/stent & us","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7548",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Exch neph cath w/ dil stric","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C7555",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rmvl thyrd w/autotran parath","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2]
["C8908",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mri w/o fol w/cont, breast,",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C8924",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2d tte w or w/o fol w/con,fu",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C8931",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mra, w/dye, spinal canal",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9053",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj,  crizanlizumab-tmca","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9056",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, givosiran","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9088",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Instill, bupivac and meloxic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["C9248",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, clevidipine butyrate",3.9876,3.9876,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["C9352",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Neuragen nerve guide, per cm",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9363",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Integra meshed bil wound mat",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9507",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"COVID-19 CONVALESCENT PLASMA",0,788.47529999999995,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9606",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Perc d-e cor revasc w ami s","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9751",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Microwave bronch, 3d, ebus",0,8841.3348060000008,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR",2,28]
["C9756",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fluorescence lymph map w/icg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2]
["C9763",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cardiac mri seg dys stress","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2]
["C9775",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Revasc lith-sten-ath tib/per","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["C9782",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Blind myocar trpl bon marrow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["D0170",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Re-eval,est pt,problem focus",86.4,86.4,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D0273",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bitewings - three images",65.599999999999994,65.599999999999994,"000",0,0,0,1,0,0,0,0,0,null,"F",null,null,2,8]
["D0330",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Panoramic image",139.19999999999999,139.19999999999999,"000",0,0,0,1,0,0,0,0,0,null,"F",null,null,2,8]
["D0373",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tomo bitewing image","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D0385",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Max mri image capture",633.6,633.6,"000",0,0,0,1,4,0,0,0,0,null,"F",null,null,2,8]
["D0388",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bitewing image capture only","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D0418",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Analysis of saliva sample","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D0470",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diagnostic casts",155.19999999999999,155.19999999999999,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D0483",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Indirect immunofluorescence","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D0603",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Caries risk assess high risk",93.6,93.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D0708",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraoral bite radio image","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,8]
["D1320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tobacco counseling",0,0,"000",0,0,0,0,0,0,0,0,0,null,"B",null,null,2,8]
["D1355",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Caries med app per tooth","Not Covered","Not Covered","000",0,0,0,5,0,0,0,0,0,null,"X",null,null,2,8]
["D1517",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fixed bilat space maint, man",505.6,505.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D1702",null,{"$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]
["D1782",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Janssen Covid-19 vaccine administration","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D2391",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post 1 srfc resinbased cmpst",223.2,223.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D2520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dental inlay metallic 2 surf","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X",null,null,2,8]
["D2644",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dental onlay porc 4/more sur","Not Covered","Not Covered","010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X",null,null,2,8]
["D2740",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown porcelain/ceramic",1352,1352,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D2782",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown 3/4 cast noble metal",1276.8,1276.8,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D2791",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown full cast base metal",1248.8,1248.8,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D2932",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prefabricated resin crown",423.2,423.2,"000",0,0,0,5,0,0,0,0,0,null,"F",null,null,2,8]
["D2951",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tooth pin retention",94.4,94.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D2981",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inlay repair","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D3221",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gross pulpal debridement",284.8,284.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D3346",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retreat root canal anterior",1064.8,1064.8,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D3426",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Root surgery ea add root",524.79999999999995,524.79999999999995,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"F",null,null,2,8]
["D3460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endodontic endosseous implan",1811.2,1811.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D3472",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surg rep root res premolar",800.8,800.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D4211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gingivectomy/plasty 1 to 3",425.6,425.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D4249",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown lengthen hard tissue",961.6,961.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D4275",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-auto graft 1st tooth",1292,1292,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D4322",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Splint intra-coronal",588.79999999999995,588.79999999999995,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dentures complete maxillary",2152,2152,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D5225",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Maxillary part denture flex",1880.8,1880.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5286",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rem unilat dent 1 pc resin",1433.6,1433.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D5421",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dentures adjust part maxill",112,112,"000",0,0,0,5,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D5711",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dentures rebase cmplt mand",717.6,717.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5725",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rebase hybrid prosthesis","By Report","By Report","000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM",2,8]
["D5820",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Denture interm part maxill",861.6,861.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5865",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Overdenture complete mandib",2756.8,2756.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D5916",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ocular prosthesis","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D5933",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Refitting of obturator",729.6,729.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D5953",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult speech aid","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D5958",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraoral con def inter plt","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D6010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Odontics endosteal implant",2236.8000000000002,2236.8000000000002,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D6013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surgical place mini implant",1524,1524,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D6063",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abutment supported mtl crown",1586.4,1586.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6070",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abutment supported retainer",1564.8,1564.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6085",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Provisional implant crown",652.79999999999995,652.79999999999995,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6095",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Odontics repr abutment",836.8,836.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6104",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bone graft time of implant",841.6,841.6,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6107",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tissue regen non-resorbable","By Report","By Report","000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM",2,8]
["D6191",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Semi precision abutment",797.6,797.6,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-ONC",2,8]
["D6195",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abut retain porc to titanium",1723.2,1723.2,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-ONC",2,8]
["D6243",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pontic porcelain to titanium",1355.2,1355.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D6548",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Porcelain/ceramic retainer","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D6610",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onlay cst hgh nbl mtl 2 srfc","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["D6720",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retain crown resin w hi nble",1295.2,1295.2,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6781",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown 3/4 cast based metal",1266.4000000000001,1266.4000000000001,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D6784",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retainer crown 3/4 titanium",1402.4,1402.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D7220",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Impact tooth remov soft tiss",392.8,392.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D7241",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Impact tooth rem bony w/comp",670.4,670.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,null,2,8]
["D7287",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Exfoliative cytolog collect",261.60000000000002,261.60000000000002,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7295",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bone harvest,auto graft proc",1205.5999999999999,1205.5999999999999,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D7410",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rad exc lesion up to 1.25 cm",529.6,529.6,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"F",null,"Y-CM",2,8]
["D7451",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rem odontogen cyst > 1.25 cm",1092,1092,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"F",null,"Y-CM",2,8]
["D7509",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Marsupialization odon cyst","By Report","By Report","090",0.1,0.69,0.21,0,2,1,1,0,0,null,"N",null,"Y-CM",2,8]
["D7520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"I&d abscess extraoral",634.4,634.4,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7720",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Clsd reduct compd maxilla fx",3895.2,3895.2,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"F",null,"Y-CM",2,8]
["D7750",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Open red comp malar/zygma fx",5025.6000000000004,5025.6000000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"F",null,"Y-CM",2,8]
["D7870",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tmj aspiration joint fluid",728,728,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7873",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tmj arthroscopy lysis adhesn",4891.2,4891.2,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7921",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Collect & appl blood product",529.6,529.6,"000",0,0,0,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7946",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reconstruction maxilla total",10613.6,10613.6,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7962",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lingual frenectomy","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D7970",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Excision hyperplastic tissue",603.20000000000005,603.20000000000005,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D7999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oral surgery procedure",732,732,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D8030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Limited dental tx adolescent",3708.8,3708.8,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,8]
["D8701",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repair fixed retainer max",334.4,334.4,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D8704",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replace broken retainer man",352,352,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-ONC",2,8]
["D9230",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Analgesia",107.2,107.2,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9420",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospital/asc call",368,368,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9930",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Treatment of complications",150.4,150.4,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D9933",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Clean & inspect rem dent man",113.60000000000001,113.60000000000001,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9961",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dup/copy patient's records","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D9972",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Extrnl bleaching per arch","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,8]
["E0100","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cane adjust/fixed with tip",28.590600000000002,28.590600000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0111","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Crutch forearm each",72.226200000000006,72.226200000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0140","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Walker w trunk support",39.004800000000003,39.004800000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0147","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Walker variable wheel resist",596.79180000000008,596.79180000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0156","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Walker seat attachment",25.5,25.5,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0159","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Brake for wheeled walker",19.8186,19.8186,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0172","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Seat lift mechanism toilet","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0181","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Press pad alternating w/ pum",27.6114,27.6114,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0191","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Protector heel or elbow",11.515799999999999,11.515799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0196","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gel pressure mattress",422.99399999999997,422.99399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0215",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electric heat pad moist","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0232","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Warming card for nwt","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["E0247","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Trans bench w/wo comm open",132.44640000000001,132.44640000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0256","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hospital bed var ht w/o matt",86.751000000000005,86.751000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0266","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed total elec w/o matt",178.76519999999999,178.76519999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0271","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Mattress innerspring",208.87559999999999,208.87559999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0292","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed var ht no sr w/matt",87.607799999999997,87.607799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0294","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed semi-elect w/ mattr",1155.558,1155.558,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0297","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed total elect w/o mat",141.5352,141.5352,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0310","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Rails bed side full length",185.01779999999999,185.01779999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0370","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Air elevator for heel","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oxygen system gas portable","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0442","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Stationary o2 contents, liq",86.302606762944009,86.302606762944009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0445","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Oximeter non-invasive","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["E0470","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Rad w/o backup non-inv intfc",2197.5899999999997,2197.5899999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0471","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Rad w/backup non inv intrfc",548.90279999999996,548.90279999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0482","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cough stimulating device",5833.2780000000002,5833.2780000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0560","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Humidifier supplemental w/ i",23.490600000000001,23.490600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0580","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Nebulizer for use w/ regulat",156.51899999999998,156.51899999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0605","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Vaporizer room type",35.832600000000006,35.832600000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0617","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Automatic ext defibrillator",4124.1660000000002,4124.1660000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0619",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Apnea monitor w recorder","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0636","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pt support & positioning sys",1347.0221999999999,1347.0221999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0638","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Standing frame sys",496.67400000000004,496.67400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0642","NU",{"$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]
["E0657","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Segmental pneumatic chest",736.33799999999997,736.33799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0669","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Seg pneumatic appli half leg",248.66579999999999,248.66579999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0672","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pressure pneum appl full arm",43.809000000000005,43.809000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0676",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inter limb compress dev nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0731",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Conductive garment for tens/","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0760","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Osteogen ultrasound stimltor",4385.6021999999994,4385.6021999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["E0761","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Nontherm electromgntc device","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0770","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Functional electric stim nos",437.07639999999998,437.07639999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0784","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Ext amb infusn pump insulin",5452.41,5452.41,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0849","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cervical pneum trac equip",699.10800000000006,699.10800000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0856","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cervic collar w air bladders",20.8794,20.8794,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0880","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Trac stand free stand extrem",26.734200000000001,26.734200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0930","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Fracture frame free standing",619.548,619.548,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0948","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Fracture frame attachmnts ce",79.539600000000007,79.539600000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0951","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Loop heel",19.3596,19.3596,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0955","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cushioned headrest",20.961000000000002,20.961000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0961","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair brake extension",3.3966000000000003,3.3966000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0971","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair anti-tipping devi",4.8552,4.8552,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0980","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair safety vest",44.839199999999998,44.839199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0986","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Man w/c push-rim powr system",6598.3799999999992,6598.3799999999992,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0990","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair elevating leg res",102.56099999999999,102.56099999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1005","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwr seat recline pwr",613.37700000000007,613.37700000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1007","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwr seat combo w/shear",9782.4120000000003,9782.4120000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1010","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Add pwr leg elevation",131.9982,131.9982,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1029","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"W/c vent tray fixed",431.86800000000005,431.86800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1036","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Patient transfer system >300",1123.7136,1123.7136,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1083","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hemi-wheelchair fixed arms",1068.0419999999999,1068.0419999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1089","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair lightwt fixed arm",165.55799999999999,165.55799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1090","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair lightweight det a",375.26479999999998,375.26479999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1160","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair fixed arms",847.92599999999993,847.92599999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1161","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Manual adult wc w tiltinspac",320.94299999999998,320.94299999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1180","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair amputee w/ foot r",1168.4099999999999,1168.4099999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1222","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair spec size w/ leg",91.932599999999994,91.932599999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1226","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Manual fully reclining back",608.58299999999997,608.58299999999997,"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",107.0796,107.0796,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1285","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair heavy duty fixed",2240.5515999999998,2240.5515999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1353","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Oxygen supplies regulator",26.838599999999996,26.838599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1372","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Oxy suppl heater for nebuliz",23.980200000000004,23.980200000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1392","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Portable oxygen concentrator",51.448799999999999,51.448799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1570","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Adjustable chair for esrd pt","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1610","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Reverse osmosis h2o puri sys",36.120999999999995,36.120999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1699","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Dialysis equipment noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["E1812","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Knee ext/flex w act res ctrl",116.6472,116.6472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1830","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Adjust toe ext/flex device",171.39060000000001,171.39060000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2000","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gastric suction pump hme mdl",70.308600000000013,70.308600000000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E2204","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Frame depth 22 to 25 in",1011.6666,1011.6666,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2205","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Manual wc accessory, handrim",4.3757999999999999,4.3757999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2213","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pneumatic prop tire insert",39.208799999999997,39.208799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2220","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Solid propuls tire, repl, ea",37.576800000000006,37.576800000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2231","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Solid seat support base",191.07660000000001,191.07660000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2310","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Electro connect btw control",131.91660000000002,131.91660000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2321","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hand interface joystick",1792.1399999999999,1792.1399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2324","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Chin cup interface",51.2346,51.2346,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2330","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Head control proximity switc",3995.34,3995.34,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2331","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Attendant control","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["E2359","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gr34 sealed leadacid battery",222.72720000000001,222.72720000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2363","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gr24 sealed leadacid battery",199.94040000000001,199.94040000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2369","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwr wc drivewheel gear repl",505.71599999999995,505.71599999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2373","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hand/chin ctrl spec joystick",93.941999999999993,93.941999999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2382","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Tube, pneum wheel drive tire",22.807199999999998,22.807199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2385","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Tube, pneumatic caster tire",54.539400000000001,54.539400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2391","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Solid caster tire",23.031599999999997,23.031599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2392","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Solid caster tire, integrate",5.8140000000000001,5.8140000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2500","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Sgd digitized pre-rec <=8min",530.44079999999997,530.44079999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2506","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Sgd prerec msg > 40 min",313.73160000000001,313.73160000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2602","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gen w/c cushion wdth >=22 in",122.4204,122.4204,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2609","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Custom fabricate w/c cushion","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E2622","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Adj skin pro w/c cus wd<22in",375.72720000000004,375.72720000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E8000",null,{"$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]
["G0009",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Admin pneumococcal vaccine",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["G0031",null,{"$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]
["G0047",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped blunt hd traum","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0050",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w/ lmted life expec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0062",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Audiology ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0069",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adm of immune drug in home","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0085",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Care man h v ext pt 75 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0106",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Colon ca screen;barium enema",425.71100000000001,425.71100000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G0109",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diab manage trn ind/group",28.5792,28.5792,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
["G0120",26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Colon ca scrn; barium enema",108.36280000000001,108.36280000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
["G0144",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scr c/v cyto,thinlayer,rescr",62.437399999999997,62.437399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["G0148",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scr c/v cyto, autosys, rescr",45.354799999999997,45.354799999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["G0168",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Wound closure by adhesive",236.37380000000002,26.197600000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2]
["G0182",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice care supervision","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0219",26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pet img wholbod melano nonco","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2]
["G0249",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Provide inr test mater/equip",128.60640000000001,128.60640000000001,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2]
["G0255","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Current percep threshold tst","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2]
["G0271",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Group mnt 2 or more 30 mins","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0289",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Arthro, loose body + chondro",151.827,151.827,"000",0,0,0,0,0,1,0,0,0,null,"R",null,null,2]
["G0295",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electromagnetic therapy onc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Two-way audio and video hhs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0330",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electromagntic tx for ulcers","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0380",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lev 1 hosp type b ed visit",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["G0397",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol/subs interv >30 min","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0410",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Grp psych partial hosp 45-50",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["G0416","TC",{"$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]
["G0432",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eia hiv-1/hiv-2 screen",27.789400000000001,27.789400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["G0436",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tobacco-use counsel 3-10 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0452",26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Molecular pathology interpr",84.54679999999999,84.54679999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
["G0463",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospital outpt clinic visit",0,0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["G0476",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hpv combo assay ca screen","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0493",null,{"$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]
["G0508",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crit care telehea consult 60","Not Covered","Not Covered","000",0,0,0,0,0,0,9,0,0,null,"X",null,null,2]
["G0517",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Remove drug implant",412.01679999999999,198.26820000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-ONC",2]
["G1004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cdsm ndsc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cdsm stanson","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1022",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cdsm intermountain","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post d/c h vst new pt 20 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post-d/c h vst ext pt 75 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2067",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med assist tx meth wk","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2079",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Take-hom buprenorphine","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2082",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Visit esketamine 56m or less",1571.2606000000001,63.112400000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-ONC",2]
["G2100",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt 66+ frailty and med dem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2107",null,{"$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]
["G2136",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bk pain vas 6-20wk = 3","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2139",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bk pain vas 9-20mo > 3","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2151",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dx degen neuro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2174",null,{"$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]
["G2186",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt ref app rsrcs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2189",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Img hd abnml neuro exam","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2206",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adjv trtmt chemo her2","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No neck fs prom no rsn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endocrinology ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4007",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"General surgery ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4019",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oncology/hema ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4026",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Phys/occ therapy ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4038",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vascular surgery ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G6003",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Radiation treatment delivery",292.93680000000001,292.93680000000001,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G6013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Radiation treatment delivery",451.90859999999998,451.90859999999998,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G6017",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intrafraction track motion","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
["G8420",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Calc bmi norm parameters","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8428",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cur meds not document","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8476",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bp sys <140 and dias <90","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scr dep neg, no plan reqd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8562",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt no hx act drain 90 d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8569",null,{"$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]
["G8635",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No pharm ther osteo rx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8656",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rafscrs llfai scor < 0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8668",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rafscrs ewh scor < 0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8696",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Antithromb thx presc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8734",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc neg elder mal no plan","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8756",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No bp measure doc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8825",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not disch to home day#7","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8841",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No sleep apnea assess","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8856",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ref for oto eval","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8869",null,{"$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]
["G8885",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No rev, comm, track biopsy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8909",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt doc no burn prior to d/c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8916",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w iv ab given on time","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8946",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mibm but no dx of breast ca","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8967",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Warf or other fda drug presc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mccd, risk adj lo, initial","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9050",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oncology work-up evaluation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9058",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc prac mgmt disagree w/gui","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9068",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx sclc/nsclc limited","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9071",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx brst stg1-2b hr,nopro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9079",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx prostate t3b-t4noprog","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9093",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx rectal t4,n,m0 no prg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9105",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx pancreatc p r0 res no","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9112",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx head/neck ext unknown","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9130",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx multi myeloma unknown","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9133",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx prostate clinical met","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9190",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medical reason for no beta","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc of dsm-iv init eval","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9229",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ptrsn no gc chl syp test","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9276",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc of tobacco user","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9288",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc medrsn no hist type rpt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9295",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non cutaneous loc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9312",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surgical site infection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9319",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Image not std nomenclature","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9354",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"1 or no ct sinus w/in 90d dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9357",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pp eval/edu perf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9382",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No off assis eol","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9405",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Recd f/u w/in 7d dc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9417",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not 1 tdap betw 10-13 yrs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9424",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Site no lung or lung cx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9453",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt reas no hcv infect","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No tob assess or cess inter","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9497",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rec inst no smoke day surg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9498",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abx reg prescribed","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9509",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adit mdd dys rem 12 mnths","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9521",null,{"$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]
["G9539",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intent pot remv time placemt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9553",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prior thyroid dise dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9598",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Aor ane 5.5-5.9 cm max diam","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9608",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraop cyst eval not done","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9627",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt no bl srg 30 day pst srg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9628",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt bwli srg 30 day pst srg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9645",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Had smoke b/4 anes day surg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9662",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prior dx/active clin ascvd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9676",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"40-75y w/type 1/2 w/ldl-c rs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9698",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sys rsn no presc bronchdil","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9711",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt hx tot col or colon ca","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9719",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not ambul/immob/wc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9731",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt unbl cmplt ft/ank fs prom","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9732",null,{"$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]
["G9744",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not eli d/t act dig htn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9761",null,{"$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]
["G9768",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w/hosp anytime msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9782",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt no daily asa/antiplat","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9813",null,{"$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]
["G9839",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anti-egfr mon anti ther","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9846",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt died from cancer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9853",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Icu stay last 30d life","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9877",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2 em core ms mo 10-12 no wl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9885",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2 em ongoing ms mo 22-24 wl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9901",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt 66+ snp or ltc pos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9916",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Funct status past 12 months","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9923",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Safty cncrns scrn and neg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9945",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w/cancer  scoliosis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9958",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No combo prohpyl thrp for pt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9962",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Embolization doc separatly","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9977",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"DIL MAC EXAM NO PERF RSN NOS ","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9993",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pall serv during meas","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0006",null,{"$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]
["H0013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol and/or drug services","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["H0025",null,{"$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]
["H0037",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Comm psy sup tx pgm per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0044",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Supported housing, per month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0048",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spec coll non-blood:a/d test","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,17]
["H1011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Family assessment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Skills train and dev, 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2026",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Supp maint employ, per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2033",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Multisys ther/juvenile 15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J0132",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Acetylcysteine injection",0.76,0.76,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0185",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., aprepitant, 1 mg",1.81,1.81,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Methyldopate hcl injection",40,40,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0219",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj aval alfa-nqpt 4mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0275",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alprostadil urethral suppos",65.12,65.12,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0288",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ampho b cholesteryl sulfate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0380",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj metaraminol bitartrate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0470",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dimecaprol injection",57.76,57.76,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0561",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Penicillin g benzathine inj",18.59,18.59,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0586",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abobotulinumtoxina",8.6999999999999993,8.6999999999999993,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0595",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Butorphanol tartrate 1 mg",3.39,3.39,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0598",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"C-1 esterase, cinryze","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0638",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Canakinumab injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0691",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj lefamulin 1 mg",0.72,0.72,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0710",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cephapirin sodium injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0720",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chloramphenicol sodium injec",40.270000000000003,40.270000000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0780",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prochlorperazine injection",2.98,2.98,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0881",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Darbepoetin alfa, non-esrd",3.09,3.09,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0890",null,{"$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,"Y-CM",2,16]
["J0893",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, decitabine (sun pharma)",1.88,1.88,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1097",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Phenylep ketorolac opth soln",116.25,116.25,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Digoxin injection",7.36,7.36,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dimethyl sulfoxide 50% 50 ml",638.70000000000005,638.70000000000005,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1267",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doripenem injection",0.79,0.79,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1325",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Epoprostenol injection",15.77,15.77,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ethanolamine oleate 100 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1443",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj ferric pyrophosphate cit",0.03,0.03,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1447",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj tbo filgrastim 1 microg",0.39,0.39,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1555",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj cuvitru, 100 mg",14.91,14.91,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1560",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gamma globulin > 10 cc inj",483.2,483.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1573",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hepagam b intravenous, inj",84.84,84.84,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1602",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Golimumab for iv use 1mg",13.85,13.85,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1643",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj heparin, pfizer, 1000u","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J1675",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Histrelin acetate",0.97,0.97,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,24]
["J1744",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Icatibant injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1747",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, spesolimab-sbzo, 1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1885",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ketorolac tromethamine inj",0.49,0.49,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1940",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Furosemide injection",0.57999999999999996,0.57999999999999996,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1956",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Levofloxacin injection",0.84,0.84,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2021",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, linezolid (hospira)",15.26,15.26,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2247",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, micafungin (par pharm)",0.37,0.37,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2272",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, morphine (fresenius)",6.72,6.72,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2326",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, nusinersen, 0.1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2353",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Octreotide injection, depot",204.54,204.54,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2426",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Paliperidone palmitate inj",13.65,13.65,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oxytetracycline injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2543",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Piperacillin/tazobactam",1.34,1.34,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2590",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oxytocin injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2725",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj protirelin per 250 mcg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2779",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, susvimo 0.1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2796",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Romiplostim injection",90.61,90.61,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2800",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Methocarbamol injection",5.31,5.31,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2997",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alteplase recombinant",87.57,87.57,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fentanyl citrate injection",0.98,0.98,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3121",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj testostero enanthate 1mg",0.05,0.05,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3244",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj. tigecycline (accord)",0.6,0.6,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J3302",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Triamcinolone diacetate inj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spectinomycn di-hcl inj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3385",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Velaglucerase alfa","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3398",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj luxturna 1 billion vec g","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3486",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ziprasidone mesylate",10.119999999999999,10.119999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Edetate disodium per 150 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7100",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dextran 40 infusion",26.66,26.66,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7169",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj andexxa, 10 mg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,16]
["J7187",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Humate-p, inj",1.35,1.35,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7194",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Factor ix complex",1.58,1.58,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7207",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Factor viii pegylated recomb",1.93,1.93,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7295",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eth estr and eton monthly","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7311",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., retisert, 0.01 mg",337.68,337.68,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7314",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., yutiq, 0.01 mg",523.78,523.78,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7332",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., triluron, 1 mg",9.9,9.9,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7352",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afamelanotide implant, 1 mg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,16]
["J7507",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tacrolimus imme rel oral 1mg",0.35,0.35,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7515",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cyclosporine oral 25 mg",0.75,0.75,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7608",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Acetylcysteine non-comp unit",6.2,6.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7615",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Levalbuterol comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7635",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Atropine comp con","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7638",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dexamethasone comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7665",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mannitol for inhaler","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7676",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pentamidine comp unit dose","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7681",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Terbutaline sulf comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J8510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oral busulfan",23.42,23.42,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J8650",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nabilone oral","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J9015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Aldesleukin injection",4683.6000000000004,4683.6000000000004,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9034",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., bendeka 1 mg",16.91,16.91,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9039",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, blinatumomab",136.07,136.07,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9070",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cyclophosphamide 100 mg inj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM",2,16]
["J9120",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dactinomycin injection",546.61,546.61,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9145",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, daratumumab 10 mg",60.77,60.77,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9178",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, epirubicin hcl, 2 mg",1.3,1.3,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9204",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj mogamulizumab-kpkc, 1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Idarubicin hcl injection",44.38,44.38,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9227",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj. isatuximab-irfc 10 mg",71.7,71.7,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["J9230",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mechlorethamine hcl inj",321.72000000000003,321.72000000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9272",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, dostarlimab-gxly, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9280",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mitomycin injection",24.02,24.02,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9304",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj. pemetrexed, 10 mg",77.55,77.55,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["J9309",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, polatuzumab vedotin 1mg",118.11,118.11,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["J9330",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Temsirolimus injection",32.17,32.17,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9352",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection trabectedin 0.1mg",331.83,331.83,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9393",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, fulvestrant (teva)","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["K0001","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Standard wheelchair",50.806200000000004,50.806200000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0007","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Extra heavy duty wheelchair",177.59220000000002,177.59220000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0008","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cstm manual wheelchair/base","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["K0014","RR",{"$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","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Detach adjust armrst upper",32.303400000000003,32.303400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0040","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Adjustable angle footplate",76.561199999999999,76.561199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0043","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Ftrst lowr exten tube rep ea",2.2644000000000002,2.2644000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0051","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cam rel asm ft/legrst rep ea",6.0282,6.0282,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0065","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Spoke protectors",59.5578,59.5578,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0195","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Elevating whlchair leg rests",191.86199999999999,191.86199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0455","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pump uninterrupted infusion",359.27460000000002,359.27460000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0605","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Repl batt lithium 4.5 v",19.512599999999999,19.512599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0746","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Absorp drg >48 suc pump","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["K0812","NU",{"$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","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 1 std cap chair",4714.848,4714.848,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0825","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 2 hd cap chair",6410.0880000000006,6410.0880000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0828","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 2 xtra hd seat/back",1177.0494000000001,1177.0494000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0837","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 2 hd sing pow opt s/b",694.4058,694.4058,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0839","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp2 vhd sing pow opt s/b",9081.06,9081.06,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0842","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp2 std mult pow opt cap",615.37619999999993,615.37619999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0854","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 3 xhd seat/back",1690.3134,1690.3134,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0855","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 3 xhd cap chair",1596.7488000000001,1596.7488000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0861","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp3 std mult pow opt s/b",996.33600000000001,996.33600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0870","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 4 hd seat/back","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0879","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp4 hd sing pow opt s/b","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0898","NU",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Power wheelchair noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0899","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pow mobil dev no dmepdac","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K1003","RR",{"$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]
["K1021",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Exsuff belt incl all sup acc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K1023",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trans elec nerv periph nerv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L0112",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cranial cervical orthosis",1911.2886000000001,1911.2886000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0200",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cerv col supp adj bar & thor",865.01659999999993,865.01659999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0457",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tlso flex trnk sj-ss pre ots",1124.5228,1124.5228,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0482",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tlso rigid lined custom fab",2219.0457999999999,2219.0457999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L0621",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sio flex pelvic/sacr pre ots",123.15900000000001,123.15900000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0624",null,{"$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]
["L0636",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lso sagittal rigid panel cus",1881.423,1881.423,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0642",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lo sag ri an/pos pnl pre ots",464.82,464.82,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0861",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Halo repl liner/interface",294.32499999999999,294.32499999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tension based scoliosis orth",4370.7110000000002,4370.7110000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1060",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Thoracic pad",147.40039999999999,147.40039999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1240",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lumbar derotation pad",108.56779999999999,108.56779999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1310",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post-operative body jacket",2475.3067999999998,2475.3067999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1610",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ho frejka cov only pre cst",57.437599999999996,57.437599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1710",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Legg perthes orth newington",2599.5881999999997,2599.5881999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1820",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ko elas w/ condyle pads & jo",188.7218,188.7218,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1847",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ko dbl upright w/air pre cst",785.43599999999992,785.43599999999992,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1920",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afo sing upright w/ adjust s",586.19780000000003,586.19780000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1960",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afo pos solid ank plastic mo",725.13139999999999,725.13139999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2035",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Kafo plastic pediatric size",245.708,245.708,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2070",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hkafo torsion unilat rot str",175.93620000000001,175.93620000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2106",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afo tib fx cast plaster mold",916.84219999999993,916.84219999999993,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2184",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Limited motion knee joint",162.05260000000001,162.05260000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dorsiflexion assist each joi",92.183199999999999,92.183199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2310",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abduction bar-straight",214.58579999999998,214.58579999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2370",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Patten bottom",358.85079999999999,358.85079999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2492",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Knee lift loop drop lock rin",138.31139999999999,138.31139999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2610",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hip clevis/thrust bearing lo",375.06459999999998,375.06459999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2640",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pelvic control band & belt b",533.31079999999997,533.31079999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2670",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Thorac cont paraspinal uprig",230.68979999999999,230.68979999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2830",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Soft interface above knee se",122.90279999999998,122.90279999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Foot insert plastazote or eq",220.55160000000001,220.55160000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3070",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Arch suprt att to sho longit",43.383200000000002,43.383200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3202",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oxford w/ supinat/pronator c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L3216",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Orthoped ladies shoes dpth i",132.56190000000001,132.56190000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3254",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Orth foot non-stndard size/w",30.710999999999999,30.710999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe lift elev heel/sole cor",178.12380000000002,178.12380000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3334",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe lifts elevation heel /i",52.118399999999994,52.118399999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3450",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe heel sach cushion type",144.17959999999999,144.17959999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ortho shoe add leather insol",39.942799999999998,39.942799999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3590",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"O shoe convert to sof counte",72.943799999999996,72.943799999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3660",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"So 8 ab rstr can/web pre ots",131.577,131.577,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3760",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eo adj jt prefab custom fit",621.49239999999998,621.49239999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3900",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hinge extension/flex wrist/f",1864.3186000000001,1864.3186000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3913",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hfo w/o joints cf",336.59799999999996,336.59799999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3917",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Metacarp fx orthosis pre cst",131.34520000000001,131.34520000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3962",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sewho erbs palsey design abd",1143.201,1143.201,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3973",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sewho airplane w/jnt(s) cf",2465.2539999999999,2465.2539999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L4002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replace strap, any orthosis",36.853200000000001,36.853200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L4055",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replace non-molded calf lace",354.78820000000002,354.78820000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4360",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pneumat walking boot pre cst",482.97359999999998,482.97359999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L5010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mold socket ank hgt w/ toe f",1766.3414,1766.3414,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mold socket bent knee shin s",7217.2956999999997,7217.2956999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5220",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No knee joint with artic ali",5335.7779999999993,5335.7779999999993,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Init bk ptb plaster direct",1863.3694,1863.3694,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Perp bk ptb thermopls direct",2086.4067999999997,2086.4067999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5611",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ak 4 bar link w/fric swing",2559.7231000000002,2559.7231000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5622",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Test socket knee disarticula",606.97109999999998,606.97109999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5638",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Below knee leather socket",800.39210000000003,800.39210000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5646",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Below knee cushion socket",850.95079999999996,850.95079999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5661",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Multi-durometer symes",882.91670000000011,882.91670000000011,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5668",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bk molded distal cushion",162.7886,162.7886,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5688",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bk waist belt webbing",101.2444,101.2444,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5694",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ak pelvic control belt pad/l",349.5675,349.5675,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5706",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom shape cvr knee disart",1439.5831000000001,1439.5831000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5718",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Knee-shin exo frct swg & sta",1321.6890000000001,1321.6890000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5810",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endoskel knee-shin mnl lock",806.62779999999998,806.62779999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5824",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endo knee-shin fluid swing p",2224.9765000000002,2224.9765000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5859",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Knee-shin pro flex/ext cont",21899.651399999999,21899.651399999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5925",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Above knee manual lock",632.77750000000003,632.77750000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5975",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Combo ankle/foot prosthesis",660.28570000000002,660.28570000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5979",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Multi-axial ankle/ft prosth",4373.2577000000001,4373.2577000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Part hand little/ring",2860.3575000000001,2860.3575000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6120",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Elbow mold doub splt soc ste",4351.5280000000002,4351.5280000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6370",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Thoracic passive restor cap",2946.8064000000004,2946.8064000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Above elbow prosth tiss shap",5157.2921999999999,5157.2921999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6611",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Additional switch, ext power",586.4479,586.4479,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6620",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flexion/extension wrist unit",485.66070000000002,485.66070000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6646",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Multipo locking shoulder jnt",4492.2566999999999,4492.2566999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6650",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoulder universal joint",496.04929999999996,496.04929999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6690",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Frame typ sock interscap-tho",1330.1726000000001,1330.1726000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6693",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lockingelbow forearm cntrbal",4043.6164999999996,4043.6164999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6708",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Term dev mech hand vol open",1423.7589,1423.7589,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6722",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hook/hand, hvy dty, vol clos",2887.8784000000001,2887.8784000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6905",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hand restoration multiple fi",2840.2280000000001,2840.2280000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6920",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Wrist disarticul switch ctrl",11289.6523,11289.6523,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L7045",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pediatric electric hook","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X","Y","Y-CM",2,9]
["L7181",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electronic elbo simultaneous",57069.240700000002,57069.240700000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L7404",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Add ue prost a/e acrylic",791.66719999999998,791.66719999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L7510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prosthetic device repair rep",121.4259,121.4259,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ext breastprosthesis garment",88.671399999999991,88.671399999999991,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["L8040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nasal prosthesis",3561.0038,3561.0038,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Truss addition to std pad wa",81.089500000000001,81.089500000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prosthetic sock multi ply ak",33.235900000000001,33.235900000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8507",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trach-esoph voice pros pt in",59.651899999999998,59.651899999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8511",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Indwelling trach insert",103.59389999999999,103.59389999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8614",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cochlear device",27255.6224,27255.6224,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8617",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Coch implant trans coil repl",130.68300000000002,130.68300000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["L8631",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mcp joint repl 2 pc or more",3092.0309000000002,3092.0309000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8680",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Implt neurostim elctr each",1059.3119999999999,1059.3119999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["L8690",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Aud osseo dev, int/ext comp",6775.6912999999995,6775.6912999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["L8698",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Misc used with tot art heart","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2,9]
["M0076",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prolotherapy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M0222",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bebteleovimab injection","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["M1005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tb scr no perf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1008",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"<50% total pt outpt ra encts","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1027",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Img head (ct or mri) obtnd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1038",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt dx lum sp reg fract","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1054",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt uc in pp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1067",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hspc pt prv time meam per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1114",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oc ni pt dc 1-2 vis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1117",null,{"$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]
["M1133",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oc ni pt dc 1-2 vis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1141",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1162",null,{"$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]
["M1172",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1179",null,{"$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]
["M1191",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1194",null,{"$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]
["M1210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["P2031",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hair analysis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["P9011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Blood split unit","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9032",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Platelets, irradiated","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9044",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cryoprecipitatereducedplasma","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9052",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Platelets, hla-m, l/r, unit","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9099",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Blood component/product noc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["P9604",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"One-way allow prorated trip","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0115",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post-coital mucous exam",35.5,35.5,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["Q0144",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Azithromycin dihydrate, oral","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0169",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Promethazine hcl 12.5mg oral",0.02,0.02,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["Q0245",null,{"$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,"Y-CM",2,16]
["Q0485",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Monitor cable elec vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["Q0492",null,{"$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]
["Q0504",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pwr adpt pneum vad, rep veh","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0512",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Px sup fee anti-can sub pres","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q2036",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flulaval vacc, 3 yrs & >, im","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q2039",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Influenza virus vaccine, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q2054",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lisocabtagene mara car pos t","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q4005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup long arm adult plst",15.718200000000001,15.718200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4017",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup lng arm splint plst",11.0364,11.0364,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4026",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup hip spica fiberglas",143.0754,143.0754,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4035",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup lngleg cylndr ped p","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["Q4042",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup lng leg splnt fbrgl",41.391599999999997,41.391599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4082",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Drug/bio noc part b drug cap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["Q4102",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oasis wound matrix",12.71,12.71,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,28]
["Q4110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Primatrix",40.700000000000003,40.700000000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,28]
["Q4124",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oasis tri-layer wound matrix","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4133",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Grafix stravix prime pl sqcm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4148",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Neox neox rt or clarix cord","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4157",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Revitalon 1 square cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4164",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Helicoll, per square cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4177",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Floweramnioflo, 0.1 cc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4180",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Revita, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4206",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fluid flow or fluid gf 1 cc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4219",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surgigraft dual per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4227",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amniocore per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4244",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Procenta, per 200 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4253",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Zenith amniotic membrane psc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4260",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Signature apatch, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q5001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice or home hlth in home","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["Q5004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice in snf","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["Q5101",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, zarxio","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q5119",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj ruxience, 10 mg",29.97,29.97,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2]
["Q5126",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj alymsys 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q9954",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oral mr contrast, 100 ml",11.66,11.66,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["Q9966",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Locm 200-299mg/ml iodine,1ml",0.51,0.51,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["R0070",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transport portable x-ray",197.507410337952,197.50741033795202,"000",0,0,0,3,0,0,0,0,0,null,"F",null,null,2]
["R0340",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retraining books","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["R0399",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"TRAINING, OPTION 2, VOC COUNSELING ",10.390434000000001,10.390434000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S0014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tacrine hydrochloride, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0074",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, cefotetan disodiu","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0091",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Granisetron 1mg",6.25,6.25,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["S0132",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj ganirelix acetat 250 mcg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dextroamphetamine","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0172",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chlorambucil 2 mg",26.52,26.52,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["S0191",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Misoprostol, oral, 200 mcg",0.95,0.95,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["S0209",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Wc van mileage per mi","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0221",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medical conference, 60 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0281",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medical home, maintenance","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0340",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lifestyle mod 1st stage","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-prscrp lens","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0601",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Screening proctoscopy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0621",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Routine ophthalmological exa","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S1034",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Art pancreas system","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2054",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transplantation of multivisc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2061",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Donor lobectomy (lung)","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2107",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adoptive immunotherapy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2142",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cord blood-derived stem-cell","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2260",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Induced abortion 17-24 weeks","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2341",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chemodenerv adduct vocal","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2402",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fetal surg cong cyst malf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3655",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Antisperm antibodies test","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3844",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dna analysis deafness","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3849",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gene test niemann-pick","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ivf package","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ivf canc a aspir case rate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Monit store cryo embryo 30 d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4995",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Smoking cessation gum","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5035",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit routine device maint","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5130",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Homaker service nos per 15m","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5146",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ther fostercare child /month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Emer response sys instal&tst","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["S5518",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit cath repair kit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5522",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit picc insert no supp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8030",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scintimammography","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8185",null,{"$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]
["S8265",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Haberman feeder","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8270",null,{"$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]
["S8301",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Infect control supplies nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["S8415",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home health aide or certifie",33.712913520000001,33.712913520000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9123",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing care in home rn",67.788700581887994,67.788700581887994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9124",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing care, in the home; b",48.965861520575999,48.965861520575999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9125",null,{"$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",45.545533203455996,45.545533203455996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9465",null,{"$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]
["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]
["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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intensive outpatient psychia","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,17]
["S9482",null,{"$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]
["S9563",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj immuno diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9590",null,{"$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",29.492056747296004,29.492056747296004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9982",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med record copy per page",0.58476580905600006,0.58476580905600006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9986",null,{"$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]
["T1032",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sv doula brth wrk per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1033",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sv doula brth wrk 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",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4522",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper med",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4523",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper lg",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4524",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper xl",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4525",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on sm",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4526",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on med",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4527",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on lg",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4528",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on xl",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4529",null,{"$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",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4534",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Youth size pull-on",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4535",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disposable liner/shield/pad",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4536",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reusable pull-on any size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4537",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reusable underpad bed size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",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",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4540",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reusable underpad chair size",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4541",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Large disposable underpad",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4542",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Small disposable underpad",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4543",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adlt disp und/pull on abv xl",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2]
["T4545",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Incon disposable penile wrap",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2019-ncov diagnostic p",51.006399999999999,51.006399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["U0002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Covid-19 lab test non-cdc",72.860200000000006,72.860200000000006,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["V0028",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Travel, vocational services, claimant","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2]
["V2020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vision svcs frames purchases",82.62,82.62,"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",52.193400000000004,52.193400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2101",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Single visn sphere 4.12-7.00",53.672399999999996,53.672399999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2102",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Singl visn sphere 7.12-20.00",67.656599999999997,67.656599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2103",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 4.00d/12-2.00d",49.572000000000003,49.572000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2104",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 4.00d/2.12-4d",51.020400000000002,51.020400000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2105",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.00d/4.25-6d",57.558599999999998,57.558599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2106",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.00d/>6.00d",61.750799999999998,61.750799999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2107",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/12-2d",53.519399999999997,53.519399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2108",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/2.12-4d",52.224000000000004,52.224000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2109",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/4.25-6d",64.106999999999999,64.106999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/over 6d",57.007800000000003,57.007800000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2111",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 7.25d/.25-2.25",59.425199999999997,59.425199999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2112",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 7.25d/2.25-4d",65.840999999999994,65.840999999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2113",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 7.25d/4.25-6d",77.764799999999994,77.764799999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2114",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder over 12.00d",84.731399999999994,84.731399999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2115",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens lenticular bifocal",102.32639999999999,102.32639999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2118",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens aniseikonic single",96.573600000000013,96.573600000000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2121",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lenticular lens, single",108.0894,108.0894,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2199",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens spher bifoc plano 4.00d",74.266199999999998,74.266199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2201",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere bifocal 4.12-7.0",74.561999999999998,74.561999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2202",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere bifocal 7.12-20.",81.997799999999998,81.997799999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2203",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifocal 4.00d/.1",72.868799999999993,72.868799999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2204",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.00d/2.1",73.225800000000007,73.225800000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2205",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.00d/4.2",75.775800000000004,75.775800000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2206",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.00d/ove",76.367400000000004,76.367400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2207",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7d/.",71.226600000000005,71.226600000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2208",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7/2.",69.880200000000002,69.880200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2209",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7/4.",80.661599999999993,80.661599999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7/ov",91.473600000000005,91.473600000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifo 7.25-12/.25-",99.878399999999999,99.878399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifo 7.25-12/2.2",100.6332,100.6332,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2213",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifo 7.25-12/4.2",96.910200000000003,96.910200000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2214",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifocal over 12.",101.745,101.745,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2215",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens lenticular bifocal",122.2266,122.2266,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2218",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens aniseikonic bifocal",127.94880000000001,127.94880000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2219",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens bifocal seg width over",51.877200000000002,51.877200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2220",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens bifocal add over 3.25d",42.075000000000003,42.075000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2221",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lenticular lens, bifocal",112.8732,112.8732,"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",87.964799999999997,87.964799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2301",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere trifocal 4.12-7.",92.432400000000001,92.432400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2302",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere trifocal 7.12-20",95.553600000000003,95.553600000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2303",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.0/.12-",87.414000000000001,87.414000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2304",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.0/2.25",80.784000000000006,80.784000000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2305",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.0/4.25",91.034999999999997,91.034999999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2306",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl trifocal 4.00/>6",93.421800000000005,93.421800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2307",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.25-7/.",94.992599999999996,94.992599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2308",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifocal 4.25-7/2.",105.3456,105.3456,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2309",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifocal 4.25-7/4.",108.9156,108.9156,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2310",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifocal 4.25-7/>6",103.9992,103.9992,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2311",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifo 7.25-12/.25-",103.8156,103.8156,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2312",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifo 7.25-12/2.25",106.9164,106.9164,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2313",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifo 7.25-12/4.25",119.92139999999999,119.92139999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2314",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl trifocal over 12",125.23560000000001,125.23560000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2315",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens lenticular trifocal",141.75960000000001,141.75960000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2318",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens aniseikonic trifocal",170.9316,170.9316,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2319",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens trifocal seg width > 28",57.8748,57.8748,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens trifocal add over 3.25d",69.084600000000009,69.084600000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2321",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lenticular lens, trifocal",137.0472,137.0472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2399",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens variab asphericity sing",123.62400000000001,123.62400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens variable asphericity bi",129.09120000000001,129.09120000000001,"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",126.276,126.276,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens pmma-toric/prism",144.2688,144.2688,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2502",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens pmma bifocal",177.72480000000002,177.72480000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2503",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens pmma color vision",174.6036,174.6036,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct gas permeable sphericl",161.8638,161.8638,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2511",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct toric prism ballast",185.77260000000001,185.77260000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2512",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens gas permbl bifocl",219.50399999999999,219.50399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2513",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens extended wear",201.22560000000001,201.22560000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens hydrophilic",136.28220000000002,136.28220000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2521",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophilic toric",211.57860000000002,211.57860000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2522",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophil bifocl",205.9074,205.9074,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2523",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophil extend",179.18339999999998,179.18339999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2524",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophil photoch",157.44720000000001,157.44720000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",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",259.88580000000002,259.88580000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2531",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens gas permeable",619.39499999999998,619.39499999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2599",null,{"$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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2624",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Polishing artifical eye","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2625",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Enlargemnt of eye prosthesis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2626",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reduction of eye prosthesis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2627",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scleral cover shell","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2628",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fabrication & fitting","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2629",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anter chamber intraocul lens",138.6996,138.6996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2631",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Iris support intraoclr lens",138.6996,138.6996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2632",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post chmbr intraocular lens",138.6996,138.6996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2700",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Balance lens",51.050999999999995,51.050999999999995,"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",74.715000000000003,74.715000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2715",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prism lens/es",16.656599999999997,16.656599999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2718",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fresnell prism press-on lens",33.272399999999998,33.272399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2730",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Special base curve",24.5718,24.5718,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2744",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tint photochromatic lens/es",21.164999999999999,21.164999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2745",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tint, any color/solid/grad",14.310599999999999,14.310599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2750",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anti-reflective coating",22.236000000000001,22.236000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2755",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Uv lens/es",20.726400000000002,20.726400000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2756",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scratch resistant coating",18.666,18.666,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2761",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Polarization, any lens",68.1768,68.1768,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2770",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Occluder lens/es",22.95,22.95,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2780",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oversize lens/es",14.596200000000001,14.596200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2781",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens, 1.54-1.65 p/1.60-1.79g",73.644000000000005,73.644000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2783",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens, >= 1.66 p/>=1.80 g",83.007599999999996,83.007599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2784",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens polycarb or equal",53.988599999999998,53.988599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2785",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing screening",91.717702551228101,91.717702551228101,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Assessment for hearing aid",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5]
["V5011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid fitting/checking",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5]
["V5014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid repair/modifying",61.14888672976101,61.14888672976101,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,5]
["V5020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Conformity evaluation",0,0,"000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5]
["V5030",null,{"$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",2,5]
["V5080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glasses bone conduction","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5090",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glasses binaural hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dispensing fee binaural",1736.5923668473672,1736.5923668473672,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disp fee contralateral monau",1040.870429738321,1040.870429738321,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5211",null,{"$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",2,5]
["V5240",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disp fee contralateral binau",1040.870429738321,1040.870429738321,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5241",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dispensing fee, monaural",868.2961834236836,868.2961834236836,"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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Battery for hearing device",1.0692332485417442,1.0692332485417442,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,5]
["V5267",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald telephone amplifier","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5269",null,{"$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,2,5]
["V5270",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald, tv amplifier, any type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5271",null,{"$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,2,5]
["V5272",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tdd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5273",null,{"$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,2,5]
["V5274",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald unspecified","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5275",null,{"$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,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm system, monaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5282",null,{"$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,2,5]
["V5283",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald neck, loop ind receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5284",null,{"$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,2,5]
["V5285",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm aud input receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5286",null,{"$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,2,5]
["V5287",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm receiver, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5288",null,{"$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,2,5]
["V5289",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm adapt/boot couplin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5290",null,{"$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,2,5]
["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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["TC","No",null,"mod1",""]
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["RR",null,null,"code1",{"$f":"UPPER('Lookup Tool'!B3)","v":"E0621"}]
["TC",null,null,"mod4",{"$f":"E2","v":"NU"}]
["TF",null,null,"mod5","TC"]
["TG",null,null,"code2",{"$f":"up","v":{"$error":"#NAME?"}}]
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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/2023/2023MARFSChapter1.pdf","Chapter 1: Introduction"]
[null,2,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter2.pdf","Chapter 2: Information for All Providers"]
[null,3,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter3.pdf","Chapter 3: Ambulance Services"]
[null,4,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter4.pdf","Chapter 4: Ambulance, Taxi, and Other Transportation Services"]
[null,5,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter5.pdf","Chapter 5: Audiology and Hearing Services"]
[null,6,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter6.pdf","Chapter 6: Biofeedback, Electrocardiograms (EKG), Electrodiagnostic services, & Extracorporeal Shockwave Therapy (ESWT)"]
[null,7,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter7.pdf","Chapter 7: Chiropractic Services"]
[null,8,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter8.pdf","Chapter 8: Dental Services"]
[null,9,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter9.pdf","Chapter 9: Durable Medical Equipment (DME)"]
[null,10,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter10.pdf","Chapter 10: Evaluation and Management (E/M) Services"]
[null,11,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter11.pdf","Chapter 11: Home Health Services"]
[null,12,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter12.pdf","Chapter 12: Impairment Rating Services"]
[null,13,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter13.pdf","Chapter 13: Independent Medical Exams (IME)"]
[null,14,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter14.pdf","Chapter 14: Language Access Services"]
[null,15,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter15.pdf","Chapter 15: Medical Testimony"]
[null,16,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter16.pdf","Chapter 16: Medication Administration and Injections"]
[null,17,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter17.pdf","Chapter 17: Mental Health Services"]
[null,18,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter18.pdf","Chapter 18: Modifications to Home and Vehicle"]
[null,19,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MARFSChapter19.pdf","Chapter 19: Naturopathic Physicians and Acupuncture Services"]
[null,20,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter20.pdf","Chapter 20: Nurse Case Management"]
[null,21,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter21.pdf","Chapter 21: Obesity Treatment"]
[null,22,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter22.pdf","Chapter 22: Other Services"]
[null,23,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter23.pdf","Chapter 23: Pathology and Laboratory Services"]
[null,24,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter24.pdf","Chapter 24: Pharmacy Services"]
[null,25,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter25.pdf","Chapter 25: Physical Medicine Services"]
[null,26,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter26.pdf","Chapter 26: Radiology Services"]
[null,27,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter27.pdf","Chapter 27: Reports and Forms"]
[null,28,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter28.pdf","Chapter 28: Supplies, Materials, and Bundled Services"]
[null,29,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter29.pdf","Chapter 29: Surgery Services"]
[null,30,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter30.pdf","Chapter 30: Vocational Services"]
[null,31,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter31.pdf","Chapter 31: Washington RBRVS Payment System"]
[null,32,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter32.pdf","Chapter 32: Ambulatory Surgery Centers (ASCs)"]
[null,33,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter33.pdf","Chapter 33: Brain Injury Rehabilitation Services"]
[null,34,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter34.pdf","Chapter 34: Chronic Pain Management"]
[null,35,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter35.pdf","Chapter 35: Hospitals"]
[null,36,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2023/2023MarfsChapter36.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"]
["E0621","NU","Y","Patient lift sling or seat",173.28,173.28,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]