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{"sheet":"Lookup","index":0,"n_rows":24,"n_cols":39,"rows_kept":24,"cut":false,"hidden":false,"merged":[[0,0,0,11],[7,3,7,11],[12,3,13,9],[14,3,14,5],[8,3,8,9],[9,3,9,8],[10,3,10,9]]}
["Code Lookup Tool (Professional Services Fee Schedule)"]
[null,null,null,"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","LIC REQ","Prior Auth",null,null,null,"MARFS 1","MARFS 2","MARFS 3","MARFS 4"]
["Enter code -->",1004,{"$f":"A22","v":1},{"$f":"IF($C$3=1,D23,D24)","v":0},{"$f":"IF($C$3=1,E23,E24)","v":"See CPT"},{"$f":"IF($C$3=1,F23,F24)","v":206.70299999999997},88.007999999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,0,"R",0,"Y-CM",null,null,null,null,null,{"$f":"VLOOKUP($A$12,'Chapters Inclusion'!A7:V19712,{20,21,22},)","v":{"$error":"#N/A"}},{"$error":"#N/A"},{"$error":"#N/A"}]
["You can enter a modifier here before searching. -->",null,1,"MSI\n(-51)","BSI\n(-50)","ASI\n(-80)","CSI\n(-62)","TSI\n(-66)","Endo\nBase","FSI","Lic Req","Prior Auth"]
[null,null,null,{"$f":"M3","v":2},{"$f":"N3","v":0},1,0,0,0,"R",{"$f":"IFERROR(T3,\"-\")","v":0},{"$f":"IFERROR(U3,\"-\")","v":"Y-CM"},{"$f":"X3","v":0}]
[null,null,null,"MARFS","MARFS","MARFS"]
[null,null,null,{"$f":"AA3","v":{"$error":"#N/A"}},{"$f":"AB3","v":{"$error":"#N/A"}},{"$error":"#N/A"}]
[null,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,null,{"$f":"HYPERLINK(VLOOKUP($AA$3,'MARFS_URL''s'!$B$2:$C$37,2,),VLOOKUP($AA$3,'MARFS_URL''s'!$B$2:$D$37,3,))","v":{"$error":"#N/A"}}]
[null,null,null,{"$f":"HYPERLINK(VLOOKUP($AB$3,'MARFS_URL''s'!$B$2:$C$37,2,),VLOOKUP($AB$3,'MARFS_URL''s'!$B$2:$D$37,3,))","v":{"$error":"#N/A"}}]
[null,null,null,{"$f":"HYPERLINK(VLOOKUP($AC$3,'MARFS_URL''s'!$B$2:$C$37,2,),VLOOKUP($AC$3,'MARFS_URL''s'!$B$2:$D$37,3,))","v":{"$error":"#N/A"}}]
[1004]
[null,null,null,"Please click the link below for this code's Prior Authorization Information"]
[]
[null,null,null,{"$f":"HYPERLINK(VLOOKUP(Lookup!L5,'MARFS_URL''s'!B40:D43,2,),VLOOKUP(Lookup!L5,'MARFS_URL''s'!B40:D43,3,))","v":"Claim Manager Authorizations"}]
[]
[]
[]
[]
[]
[]
[{"$f":"IF(A23=\"\",1,2)","v":1}]
[null,null,null,{"$f":"VLOOKUP($C$3,'2021 Professional Fee Schedule'!$C$7:$Z$19712,{4,5,7,9,11,12,13,14,15,16,17,18,19,20,21,22,23,24},0)","v":0},"See CPT",206.70299999999997,88.007999999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,0,"R",0,"Y-CM",{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"}]
[null,null,null,{"$f":"VLOOKUP($C$3,'2021 Professional Fee Schedule'!$D$7:$Z$19712,{3,4,6,8,10,11,12,13,14,15,16,17,18,19,20,21,22,23},0)","v":{"$error":"#N/A"}},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"},{"$error":"#N/A"}]

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["Professional Services Fee Schedule"]
[]
["CPT® Through Local Codes"]
[]
[]
[]
["Effective for Dates of Service on or After"]
[]
["2021-07-01"]
[]
[]
[]
[]
[]
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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,"2020 CPT® anesthesia code.",null,null,null,null,"2020 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,"2020 CPT® or HCPCS code",null,null,null,null,null,null,null,"2020 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 2020 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"]
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[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. "]
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[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)."]
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[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). "]
[]
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[]
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[]
[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. "]
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[]
[]
[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                               This column indicates whether prior authorization and utilization review is required.",null,null,null,null,null,"Y",null,"Prior authorization required"]
[]
[null,null,null,null,null,null,null,null,"Y-UR",null,"Prior authorization and UR required"]
[]
[]
["LOCAL CODES FEE SCHEDULE"]
["FIELD KEY:  "]
["Column Title",null,"Column Description",null,null,null,null,"Column Values",null,"Value Definitions"]
["LOCAL\nCODE",null,"2021 Local Code.",null,null,null,null,null,null,"A code assigned by the department to represent a specific service that is unique to injured workers."]
["Description",null,"Local Code Description",null,null,null,null,null,null,"Description of the unique service."]
["Dollar Value Nonfacility Setting",null,"This column indicates the:\n\nMaximum dollar amount for covered services provided in a non-facility setting, or\n\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:\n\nMaximum dollar amount for covered services provided in a facility setting, or\n\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,"2020 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":"2021 Professional Fee Sched 2","index":2,"n_rows":19712,"n_cols":24,"rows_kept":2250,"cut":true,"hidden":true,"merged":[[0,2,0,13],[1,2,1,13],[4,6,4,9],[4,11,4,19]],"bounds":{"rows_first":1000,"rows_last":250,"rows_between":1000,"halvings":1}}
[null,null,"Professional Services Fee Schedule"]
[]
[]
[]
[null,null,null,null,null,null,"DOLLAR VALUE",null,null,null,null,"MODIFIERS"]
[null,null,"CODE","Modifiers","Short Description (HCPCS and Local Only)","Column1","NON-FACILITY SETTING","Column2","FACILITY SETTING","Column3","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"]
[{"$f":"SEARCH(Lookup!$B$2,C7)","v":1},1,10004,null,"See CPT",null,89.165999999999997,null,73.533000000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C8)","v":1},2,10005,null,"See CPT",null,242.02199999999999,null,122.748,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9)","v":1},3,10006,null,"See CPT",null,105.378,null,85.691999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10)","v":1},4,10007,null,"See CPT",null,562.20900000000006,null,155.751,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C11)","v":1},5,10008,null,"See CPT",null,297.02699999999999,null,99.587999999999994,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C12)","v":1},6,10009,null,"See CPT",null,863.28899999999999,null,189.91199999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13)","v":1},7,10010,null,"See CPT",null,505.46699999999998,null,136.64399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14)","v":1},8,10011,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C15)","v":1},9,10012,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C16)","v":1},10,10021,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17)","v":1},11,10030,null,"See CPT",null,1208.373,null,229.863,null,"000",0,0,0,9,2,9,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18)","v":1},12,10035,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19)","v":1},13,10036,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C20)","v":1},14,10040,null,"See CPT",null,206.70299999999997,null,88.007999999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C21)","v":1},15,10060,null,"See CPT",null,219.441,null,180.648,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C22)","v":1},16,10061,null,"See CPT",null,372.87600000000003,null,317.87099999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C23)","v":1},17,10080,null,"See CPT",null,450.46199999999999,null,185.28,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C24)","v":1},18,10081,null,"See CPT",null,613.74,null,299.92199999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C25)","v":1},19,10120,null,"See CPT",null,275.60399999999998,null,182.964,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C26)","v":1},20,10121,null,"See CPT",null,481.72800000000001,null,319.60799999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C27)","v":1},21,10140,null,"See CPT",null,305.13299999999998,null,206.124,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C28)","v":1},22,10160,null,"See CPT",null,231.6,null,165.01500000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C29)","v":1},23,10180,null,"See CPT",null,469.56899999999996,null,309.76499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C30)","v":1},24,11000,null,"See CPT",null,102.483,null,46.899000000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C31)","v":1},25,11001,null,"See CPT",null,44.003999999999998,null,23.16,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C32)","v":1},26,11004,null,"See CPT",null,974.45699999999988,null,974.45699999999988,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C33)","v":1},27,11005,null,"See CPT",null,1318.383,null,1318.383,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C34)","v":1},28,11006,null,"See CPT",null,1195.635,null,1195.635,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C35)","v":1},29,11008,null,"See CPT",null,464.35799999999995,null,464.35799999999995,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C36)","v":1},30,11010,null,"See CPT",null,839.55,null,471.88499999999999,null,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C37)","v":1},31,11011,null,"See CPT",null,925.82100000000003,null,509.52000000000004,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C38)","v":1},32,11012,null,"See CPT",null,1180.5809999999999,null,709.27499999999998,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C39)","v":1},33,11042,null,"See CPT",null,233.916,null,103.64100000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C40)","v":1},34,11043,null,"See CPT",null,416.30099999999999,null,264.60300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C41)","v":1},35,11044,null,"See CPT",null,545.99699999999996,null,383.298,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C42)","v":1},36,11045,null,"See CPT",null,72.375,null,44.003999999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C55)","v":1},49,11201,null,"See CPT",null,31.266000000000002,null,27.791999999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C56)","v":1},50,11300,null,"See CPT",null,186.43800000000002,null,57.9,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C60)","v":1},54,11305,null,"See CPT",null,194.54399999999998,null,64.847999999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C61)","v":1},55,11306,null,"See CPT",null,224.07300000000001,null,83.954999999999998,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C62)","v":1},56,11307,null,"See CPT",null,258.23399999999998,null,107.694,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C63)","v":1},57,11308,null,"See CPT",null,273.28799999999995,null,121.011,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C64)","v":1},58,11310,null,"See CPT",null,213.072,null,77.585999999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C65)","v":1},59,11311,null,"See CPT",null,249.54899999999998,null,106.536,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C66)","v":1},60,11312,null,"See CPT",null,284.28899999999999,null,125.64299999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C67)","v":1},61,11313,null,"See CPT",null,329.45100000000002,null,163.27799999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C68)","v":1},62,11400,null,"See CPT",null,232.17899999999997,null,145.32899999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C69)","v":1},63,11401,null,"See CPT",null,279.65699999999998,null,182.38499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C70)","v":1},64,11402,null,"See CPT",null,307.44899999999996,null,199.755,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C71)","v":1},65,11403,null,"See CPT",null,353.76900000000001,null,257.07600000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C72)","v":1},66,11404,null,"See CPT",null,402.40499999999997,null,283.13099999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C73)","v":1},67,11406,null,"See CPT",null,565.68299999999999,null,426.72300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C74)","v":1},68,11420,null,"See CPT",null,231.6,null,143.01300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C75)","v":1},69,11421,null,"See CPT",null,287.18399999999997,null,188.75399999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C94)","v":1},88,11602,null,"See CPT",null,438.303,null,275.60399999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C96)","v":1},90,11604,null,"See CPT",null,553.524,null,363.03299999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C97)","v":1},91,11606,null,"See CPT",null,789.17700000000002,null,541.36500000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C132)","v":1},126,11954,null,"See CPT",null,274.44600000000003,null,191.649,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C239)","v":1},233,15570,null,"See CPT",null,1605.567,null,1262.22,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C240)","v":1},234,15572,null,"See CPT",null,1547.088,null,1272.6420000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C241)","v":1},235,15574,null,"See CPT",null,1542.4559999999999,null,1269.7469999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C242)","v":1},236,15576,null,"See CPT",null,1390.1790000000001,null,1129.05,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C243)","v":1},237,15600,null,"See CPT",null,611.42399999999998,null,369.40199999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C244)","v":1},238,15610,null,"See CPT",null,659.48099999999999,null,423.24899999999997,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C245)","v":1},239,15620,null,"See CPT",null,802.49399999999991,null,569.15700000000004,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C246)","v":1},240,15630,null,"See CPT",null,823.33799999999997,null,595.79099999999994,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C247)","v":1},241,15650,null,"See CPT",null,900.34500000000003,null,657.16499999999996,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C248)","v":1},242,15730,null,"See CPT",null,2660.5050000000001,null,1579.5119999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C249)","v":1},243,15731,null,"See CPT",null,1970.337,null,1728.3150000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C250)","v":1},244,15733,null,"See CPT",null,1786.7939999999999,null,1786.7939999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C251)","v":1},245,15734,null,"See CPT",null,2587.5509999999999,null,2587.5509999999999,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C252)","v":1},246,15736,null,"See CPT",null,2105.8229999999999,null,2105.8229999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C253)","v":1},247,15738,null,"See CPT",null,2211.201,null,2211.201,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C254)","v":1},248,15740,null,"See CPT",null,1765.95,null,1445.184,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C255)","v":1},249,15750,null,"See CPT",null,1611.9359999999999,null,1611.9359999999999,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C256)","v":1},250,15756,null,"See CPT",null,3955.7279999999996,null,3955.7279999999996,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C257)","v":1},251,15757,null,"See CPT",null,3945.8850000000002,null,3945.8850000000002,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C258)","v":1},252,15758,null,"See CPT",null,3944.7269999999999,null,3944.7269999999999,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C259)","v":1},253,15760,null,"See CPT",null,1492.662,null,1213.0049999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C260)","v":1},254,15769,null,"See CPT",null,836.65499999999997,null,836.65499999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C261)","v":1},255,15770,null,"See CPT",null,1170.1590000000001,null,1170.1590000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C262)","v":1},256,15771,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C263)","v":1},257,15772,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C264)","v":1},258,15773,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C265)","v":1},259,15774,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C266)","v":1},260,15775,null,"See CPT",null,666.42899999999997,null,436.56599999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C267)","v":1},261,15776,null,"See CPT",null,904.39799999999991,null,598.10699999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C268)","v":1},262,15777,null,"See CPT",null,365.928,null,365.928,null,"000",0,0,0,0,0,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C269)","v":1},263,15780,null,"See CPT",null,1522.1909999999998,null,1146.9989999999998,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C270)","v":1},264,15781,null,"See CPT",null,972.72,null,748.06799999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C271)","v":1},265,15782,null,"See CPT",null,907.29300000000001,null,656.58600000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C272)","v":1},266,15783,null,"See CPT",null,803.07299999999998,null,610.26599999999996,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C273)","v":1},267,15786,null,"See CPT",null,429.03899999999999,null,229.28399999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C274)","v":1},268,15787,null,"See CPT",null,65.426999999999992,null,29.529,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C275)","v":1},269,15788,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C276)","v":1},270,15789,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C277)","v":1},271,15792,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C278)","v":1},272,15793,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C279)","v":1},273,15819,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C280)","v":1},274,15820,null,"See CPT",null,1010.934,null,892.23900000000003,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C281)","v":1},275,15821,null,"See CPT",null,1079.8349999999998,null,949.56,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C282)","v":1},276,15822,null,"See CPT",null,812.91599999999994,null,694.8,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C283)","v":1},277,15823,null,"See CPT",null,1085.0459999999998,null,953.03399999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C284)","v":1},278,15824,null,"See CPT",null,1530.5708246400002,null,1530.5708246400002,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C285)","v":1},279,15825,null,"See CPT",null,1316.0271009600001,null,1316.0271009600001,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C286)","v":1},280,15826,null,"See CPT",null,1244.4985238400002,null,1244.4985238400002,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C287)","v":1},281,15828,null,"See CPT",null,4262.7398299200013,null,4262.7398299200013,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C288)","v":1},282,15829,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C289)","v":1},283,15830,null,"See CPT",null,2018.9729999999997,null,2018.9729999999997,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C290)","v":1},284,15832,null,"See CPT",null,1584.723,null,1584.723,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C291)","v":1},285,15833,null,"See CPT",null,1511.19,null,1511.19,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C292)","v":1},286,15834,null,"See CPT",null,1538.982,null,1538.982,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C293)","v":1},287,15835,null,"See CPT",null,1604.9879999999998,null,1604.9879999999998,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C294)","v":1},288,15836,null,"See CPT",null,1307.961,null,1307.961,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C295)","v":1},289,15837,null,"See CPT",null,1523.9279999999999,null,1240.2180000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C296)","v":1},290,15838,null,"See CPT",null,1120.365,null,1120.365,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C297)","v":1},291,15839,null,"See CPT",null,1571.4059999999999,null,1280.748,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C298)","v":1},292,15840,null,"See CPT",null,1767.1079999999999,null,1767.1079999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C299)","v":1},293,15841,null,"See CPT",null,3061.752,null,3061.752,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C300)","v":1},294,15842,null,"See CPT",null,4635.4740000000002,null,4635.4740000000002,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C301)","v":1},295,15845,null,"See CPT",null,1742.79,null,1742.79,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C302)","v":1},296,15847,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,2,1,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C303)","v":1},297,15850,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C304)","v":1},298,15851,null,"See CPT",null,195.702,null,78.165000000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C305)","v":1},299,15852,null,"See CPT",null,78.744,null,78.744,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C306)","v":1},300,15860,null,"See CPT",null,181.22699999999998,null,181.22699999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C307)","v":1},301,15876,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C308)","v":1},302,15877,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C309)","v":1},303,15878,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C310)","v":1},304,15879,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C311)","v":1},305,15920,null,"See CPT",null,1093.731,null,1093.731,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C312)","v":1},306,15922,null,"See CPT",null,1376.8620000000001,null,1376.8620000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C313)","v":1},307,15931,null,"See CPT",null,1220.5319999999999,null,1220.5319999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C314)","v":1},308,15933,null,"See CPT",null,1503.0840000000001,null,1503.0840000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C315)","v":1},309,15934,null,"See CPT",null,1638.57,null,1638.57,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C316)","v":1},310,15935,null,"See CPT",null,1993.4969999999998,null,1993.4969999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C317)","v":1},311,15936,null,"See CPT",null,1560.9839999999999,null,1560.9839999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C318)","v":1},312,15937,null,"See CPT",null,1804.7430000000002,null,1804.7430000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C319)","v":1},313,15940,null,"See CPT",null,1215.8999999999999,null,1215.8999999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C320)","v":1},314,15941,null,"See CPT",null,1607.883,null,1607.883,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C321)","v":1},315,15944,null,"See CPT",null,1591.0920000000001,null,1591.0920000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C322)","v":1},316,15945,null,"See CPT",null,1760.1599999999999,null,1760.1599999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C323)","v":1},317,15946,null,"See CPT",null,2788.4639999999999,null,2788.4639999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C324)","v":1},318,15950,null,"See CPT",null,1066.518,null,1066.518,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C325)","v":1},319,15951,null,"See CPT",null,1555.7729999999999,null,1555.7729999999999,null,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C326)","v":1},320,15952,null,"See CPT",null,1580.67,null,1580.67,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C327)","v":1},321,15953,null,"See CPT",null,1741.6319999999998,null,1741.6319999999998,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C328)","v":1},322,15956,null,"See CPT",null,2017.2360000000001,null,2017.2360000000001,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C329)","v":1},323,15958,null,"See CPT",null,2051.3969999999999,null,2051.3969999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C330)","v":1},324,15999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C331)","v":1},325,16000,null,"See CPT",null,132.59100000000001,null,77.007000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C332)","v":1},326,16020,null,"See CPT",null,152.85599999999999,null,95.534999999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C333)","v":1},327,16025,null,"See CPT",null,277.34100000000001,null,191.07,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C334)","v":1},328,16030,null,"See CPT",null,345.084,null,225.23099999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C335)","v":1},329,16035,null,"See CPT",null,330.60899999999998,null,330.60899999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C336)","v":1},330,16036,null,"See CPT",null,133.749,null,133.749,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C337)","v":1},331,17000,null,"See CPT",null,117.53699999999999,null,94.376999999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C338)","v":1},332,17003,null,"See CPT",null,12.158999999999999,null,3.4739999999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C339)","v":1},333,17004,null,"See CPT",null,292.97399999999999,null,166.75199999999998,null,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C340)","v":1},334,17106,null,"See CPT",null,601.58100000000002,null,471.88499999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C341)","v":1},335,17107,null,"See CPT",null,786.28200000000004,null,614.31899999999996,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C342)","v":1},336,17108,null,"See CPT",null,1104.732,null,896.29200000000003,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C343)","v":1},337,17110,null,"See CPT",null,203.80799999999999,null,115.8,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C344)","v":1},338,17111,null,"See CPT",null,237.39,null,140.697,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C345)","v":1},339,17250,null,"See CPT",null,165.59399999999999,null,64.269000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C346)","v":1},340,17260,null,"See CPT",null,175.43699999999998,null,121.011,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C347)","v":1},341,17261,null,"See CPT",null,262.28700000000003,null,147.64499999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C348)","v":1},342,17262,null,"See CPT",null,314.976,null,187.017,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C349)","v":1},343,17263,null,"See CPT",null,341.03099999999995,null,207.86099999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C350)","v":1},344,17264,null,"See CPT",null,365.34899999999999,null,222.91499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C351)","v":1},345,17266,null,"See CPT",null,415.14299999999997,null,261.12899999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C352)","v":1},346,17270,null,"See CPT",null,264.02399999999994,null,161.541,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C353)","v":1},347,17271,null,"See CPT",null,292.97399999999999,null,178.33199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C354)","v":1},348,17272,null,"See CPT",null,332.92500000000001,null,206.124,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C355)","v":1},349,17273,null,"See CPT",null,368.82299999999998,null,233.33700000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C356)","v":1},350,17274,null,"See CPT",null,430.19699999999995,null,284.28899999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C357)","v":1},351,17276,null,"See CPT",null,497.93999999999994,null,341.61,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C358)","v":1},352,17280,null,"See CPT",null,248.96999999999997,null,147.64499999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C359)","v":1},353,17281,null,"See CPT",null,316.71299999999997,null,201.49199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C360)","v":1},354,17282,null,"See CPT",null,362.45399999999995,null,232.75799999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C361)","v":1},355,17283,null,"See CPT",null,427.88099999999997,null,290.07900000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C362)","v":1},356,17284,null,"See CPT",null,486.36,null,338.13599999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C363)","v":1},357,17286,null,"See CPT",null,623.00400000000002,null,459.726,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C364)","v":1},358,17311,null,"See CPT",null,1192.1610000000001,null,603.31799999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C365)","v":1},359,17312,null,"See CPT",null,727.22400000000005,null,320.76600000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C366)","v":1},360,17313,null,"See CPT",null,1120.944,null,541.36500000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C367)","v":1},361,17314,null,"See CPT",null,696.53699999999992,null,298.185,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C368)","v":1},362,17315,null,"See CPT",null,134.32799999999997,null,84.533999999999992,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C369)","v":1},363,17340,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C370)","v":1},364,17360,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C371)","v":1},365,17380,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C372)","v":1},366,17999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C373)","v":1},367,19000,null,"See CPT",null,192.80699999999999,null,72.953999999999994,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C374)","v":1},368,19001,null,"See CPT",null,46.32,null,35.897999999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C375)","v":1},369,19020,null,"See CPT",null,863.86799999999994,null,545.41800000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C376)","v":1},370,19030,null,"See CPT",null,301.65899999999999,null,127.95899999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C377)","v":1},371,19081,null,"See CPT",null,1037.568,null,279.65699999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C378)","v":1},372,19082,null,"See CPT",null,836.65499999999997,null,140.11799999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C379)","v":1},373,19083,null,"See CPT",null,1039.884,null,264.60300000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C380)","v":1},374,19084,null,"See CPT",null,822.18,null,130.85399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C381)","v":1},375,19085,null,"See CPT",null,1604.4090000000001,null,305.71199999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C382)","v":1},376,19086,null,"See CPT",null,1278.4319999999998,null,152.27699999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C383)","v":1},377,19100,null,"See CPT",null,282.55199999999996,null,118.116,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C384)","v":1},378,19101,null,"See CPT",null,609.6869999999999,null,386.77199999999999,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C385)","v":1},379,19105,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C386)","v":1},380,19110,null,"See CPT",null,893.976,null,613.74,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C387)","v":1},381,19112,null,"See CPT",null,847.077,null,562.20900000000006,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C388)","v":1},382,19120,null,"See CPT",null,910.18799999999999,null,722.01300000000003,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C389)","v":1},383,19125,null,"See CPT",null,1003.986,null,799.59900000000005,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C390)","v":1},384,19126,null,"See CPT",null,272.709,null,272.709,null,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C391)","v":1},385,19281,null,"See CPT",null,441.77699999999999,null,167.91,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C392)","v":1},386,19282,null,"See CPT",null,317.87099999999998,null,83.954999999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C393)","v":1},387,19283,null,"See CPT",null,488.67599999999993,null,169.64699999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C394)","v":1},388,19284,null,"See CPT",null,375.19200000000001,null,85.691999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C395)","v":1},389,19285,null,"See CPT",null,785.12400000000002,null,144.17100000000002,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C396)","v":1},390,19286,null,"See CPT",null,666.42899999999997,null,71.795999999999992,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C397)","v":1},391,19287,null,"See CPT",null,1350.2280000000001,null,214.809,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C398)","v":1},392,19288,null,"See CPT",null,1072.308,null,107.694,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C399)","v":1},393,19294,null,"See CPT",null,279.65699999999998,null,279.65699999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C400)","v":1},394,19296,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C401)","v":1},395,19297,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C402)","v":1},396,19298,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C403)","v":1},397,19300,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C404)","v":1},398,19301,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C405)","v":1},399,19302,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C406)","v":1},400,19303,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C407)","v":1},401,19305,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C408)","v":1},402,19306,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C409)","v":1},403,19307,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C410)","v":1},404,19316,null,"See CPT",null,1367.598,null,1367.598,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C411)","v":1},405,19318,null,"See CPT",null,1885.2240000000002,null,1885.2240000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C412)","v":1},406,19325,null,"See CPT",null,1063.0439999999999,null,1063.0439999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C413)","v":1},407,19328,null,"See CPT",null,959.40300000000002,null,959.40300000000002,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C414)","v":1},408,19330,null,"See CPT",null,1115.7329999999999,null,1115.7329999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C415)","v":1},409,19340,null,"See CPT",null,1309.6980000000001,null,1309.6980000000001,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C416)","v":1},410,19342,null,"See CPT",null,1315.4879999999998,null,1315.4879999999998,null,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C417)","v":1},411,19350,null,"See CPT",null,1461.9749999999999,null,1162.6319999999998,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C418)","v":1},412,19355,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C419)","v":1},413,19357,null,"See CPT",null,2023.0259999999998,null,2023.0259999999998,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C420)","v":1},414,19361,null,"See CPT",null,2683.0860000000002,null,2683.0860000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C421)","v":1},415,19364,null,"See CPT",null,4681.7939999999999,null,4681.7939999999999,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C422)","v":1},416,19367,null,"See CPT",null,3045.54,null,3045.54,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C423)","v":1},417,19368,null,"See CPT",null,3734.5499999999997,null,3734.5499999999997,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C424)","v":1},418,19369,null,"See CPT",null,3469.9470000000001,null,3469.9470000000001,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C425)","v":1},419,19370,null,"See CPT",null,1159.1579999999999,null,1159.1579999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C426)","v":1},420,19371,null,"See CPT",null,1230.954,null,1230.954,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C427)","v":1},421,19380,null,"See CPT",null,1394.8109999999999,null,1394.8109999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C428)","v":1},422,19396,null,"See CPT",null,514.73099999999999,null,244.91700000000003,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C429)","v":1},423,19499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C430)","v":1},424,20100,null,"See CPT",null,1035.8309999999999,null,1035.8309999999999,null,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C431)","v":1},425,20101,null,"See CPT",null,1099.521,null,363.03299999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C432)","v":1},426,20102,null,"See CPT",null,1138.3140000000001,null,439.46099999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C433)","v":1},427,20103,null,"See CPT",null,1032.357,null,594.63299999999992,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C434)","v":1},428,20150,null,"See CPT",null,1734.105,null,1734.105,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C435)","v":1},429,20200,null,"See CPT",null,407.03699999999998,null,161.541,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C436)","v":1},430,20205,null,"See CPT",null,559.31399999999996,null,264.60300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C437)","v":1},431,20206,null,"See CPT",null,440.61900000000003,null,97.850999999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C438)","v":1},432,20220,null,"See CPT",null,452.19899999999996,null,148.22399999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C439)","v":1},433,20225,null,"See CPT",null,748.06799999999998,null,221.178,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C440)","v":1},434,20240,null,"See CPT",null,243.75899999999999,null,243.75899999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C441)","v":1},435,20245,null,"See CPT",null,592.89599999999996,null,592.89599999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C442)","v":1},436,20250,null,"See CPT",null,677.43,null,677.43,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C443)","v":1},437,20251,null,"See CPT",null,739.96199999999999,null,739.96199999999999,null,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C444)","v":1},438,20500,null,"See CPT",null,210.17699999999999,null,151.69800000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C445)","v":1},439,20501,null,"See CPT",null,265.18200000000002,null,63.690000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C446)","v":1},440,20520,null,"See CPT",null,391.404,null,259.392,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C447)","v":1},441,20525,null,"See CPT",null,864.447,null,426.72300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C448)","v":1},442,20526,null,"See CPT",null,141.27599999999998,null,97.850999999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C449)","v":1},443,20527,null,"See CPT",null,151.119,null,111.747,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C450)","v":1},444,20550,null,"See CPT",null,97.850999999999999,null,66.005999999999986,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C451)","v":1},445,20551,null,"See CPT",null,100.167,null,67.163999999999987,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C452)","v":1},446,20552,null,"See CPT",null,93.798000000000002,null,64.269000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C453)","v":1},447,20553,null,"See CPT",null,108.85199999999999,null,73.533000000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C454)","v":1},448,20555,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C455)","v":1},449,20560,null,"See CPT",null,45.741,null,27.212999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C456)","v":1},450,20561,null,"See CPT",null,67.163999999999987,null,41.687999999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C457)","v":1},451,20600,null,"See CPT",null,90.323999999999998,null,60.216000000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C458)","v":1},452,20604,null,"See CPT",null,143.01300000000001,null,78.744,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C459)","v":1},453,20605,null,"See CPT",null,94.376999999999995,null,63.111000000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C460)","v":1},454,20606,null,"See CPT",null,156.33000000000001,null,89.745000000000005,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C461)","v":1},455,20610,null,"See CPT",null,111.747,null,77.585999999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C462)","v":1},456,20611,null,"See CPT",null,174.279,null,101.904,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C463)","v":1},457,20612,null,"See CPT",null,111.16799999999999,null,70.637999999999991,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C464)","v":1},458,20615,null,"See CPT",null,459.726,null,281.39400000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C465)","v":1},459,20650,null,"See CPT",null,387.351,null,274.44600000000003,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C466)","v":1},460,20660,null,"See CPT",null,410.51099999999997,null,410.51099999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C467)","v":1},461,20661,null,"See CPT",null,891.66,null,891.66,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C468)","v":1},462,20662,null,"See CPT",null,904.97699999999998,null,904.97699999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C469)","v":1},463,20663,null,"See CPT",null,833.76,null,833.76,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C470)","v":1},464,20664,null,"See CPT",null,1526.2439999999999,null,1526.2439999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C471)","v":1},465,20665,null,"See CPT",null,200.91300000000001,null,163.857,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C472)","v":1},466,20670,null,"See CPT",null,689.01,null,253.023,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C473)","v":1},467,20680,null,"See CPT",null,1091.9939999999999,null,727.22400000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C474)","v":1},468,20690,null,"See CPT",null,1031.1989999999998,null,1031.1989999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C475)","v":1},469,20692,null,"See CPT",null,1937.3340000000001,null,1937.3340000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C476)","v":1},470,20693,null,"See CPT",null,772.38599999999997,null,772.38599999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C477)","v":1},471,20694,null,"See CPT",null,764.28,null,591.73800000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C478)","v":1},472,20696,null,"See CPT",null,2058.924,null,2058.924,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C479)","v":1},473,20697,null,"See CPT",null,3818.5050000000001,null,3818.5050000000001,null,"000",0,0,0,3,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C480)","v":1},474,20700,null,"See CPT",null,142.434,null,142.434,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C481)","v":1},475,20701,null,"See CPT",null,107.11500000000001,null,107.11500000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C482)","v":1},476,20702,null,"See CPT",null,237.39,null,237.39,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C483)","v":1},477,20703,null,"See CPT",null,170.80500000000001,null,170.80500000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C484)","v":1},478,20704,null,"See CPT",null,248.39099999999999,null,248.39099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C485)","v":1},479,20705,null,"See CPT",null,204.38699999999997,null,204.38699999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C486)","v":1},480,20802,null,"See CPT",null,4715.9549999999999,null,4715.9549999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C487)","v":1},481,20805,null,"See CPT",null,5600.6670000000004,null,5600.6670000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C488)","v":1},482,20808,null,"See CPT",null,6754.6139999999996,null,6754.6139999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C489)","v":1},483,20816,null,"See CPT",null,3530.163,null,3530.163,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C490)","v":1},484,20822,null,"See CPT",null,3051.9090000000001,null,3051.9090000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C491)","v":1},485,20824,null,"See CPT",null,3537.1110000000003,null,3537.1110000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C492)","v":1},486,20827,null,"See CPT",null,3133.5479999999998,null,3133.5479999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C493)","v":1},487,20838,null,"See CPT",null,4790.6459999999997,null,4790.6459999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C494)","v":1},488,20900,null,"See CPT",null,735.32999999999993,null,313.81799999999998,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C495)","v":1},489,20902,null,"See CPT",null,476.517,null,476.517,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C496)","v":1},490,20910,null,"See CPT",null,829.12800000000004,null,829.12800000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C497)","v":1},491,20912,null,"See CPT",null,845.91899999999998,null,845.91899999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C498)","v":1},492,20920,null,"See CPT",null,702.327,null,702.327,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C499)","v":1},493,20922,null,"See CPT",null,1074.0450000000001,null,851.70900000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C500)","v":1},494,20924,null,"See CPT",null,881.23800000000006,null,881.23800000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C501)","v":1},495,20930,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C502)","v":1},496,20931,null,"See CPT",null,187.596,null,187.596,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C503)","v":1},497,20932,null,"See CPT",null,1290.5909999999999,null,1290.5909999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C504)","v":1},498,20933,null,"See CPT",null,1184.0549999999998,null,1184.0549999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C505)","v":1},499,20934,null,"See CPT",null,1289.433,null,1289.433,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C506)","v":1},500,20936,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C507)","v":1},501,20937,null,"See CPT",null,283.13099999999997,null,283.13099999999997,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C508)","v":1},502,20938,null,"See CPT",null,311.50200000000001,null,311.50200000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C509)","v":1},503,20939,null,"See CPT",null,117.53699999999999,null,117.53699999999999,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C510)","v":1},504,20950,null,"See CPT",null,496.20300000000003,null,152.27699999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C511)","v":1},505,20955,null,"See CPT",null,4253.3339999999998,null,4253.3339999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C512)","v":1},506,20956,null,"See CPT",null,4535.8860000000004,null,4535.8860000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C513)","v":1},507,20957,null,"See CPT",null,4724.6399999999994,null,4724.6399999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C514)","v":1},508,20962,null,"See CPT",null,4586.8379999999997,null,4586.8379999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C515)","v":1},509,20969,null,"See CPT",null,4707.2699999999995,null,4707.2699999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C516)","v":1},510,20970,null,"See CPT",null,4891.9709999999995,null,4891.9709999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C517)","v":1},511,20972,null,"See CPT",null,4878.6540000000005,null,4878.6540000000005,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C518)","v":1},512,20973,null,"See CPT",null,5150.7839999999997,null,5150.7839999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C519)","v":1},513,20974,null,"See CPT",null,143.01300000000001,null,86.271000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C520)","v":1},514,20975,null,"See CPT",null,302.81700000000001,null,302.81700000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C521)","v":1},515,20979,null,"See CPT",null,95.534999999999997,null,53.847000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C522)","v":1},516,20982,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C523)","v":1},517,20983,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C524)","v":1},518,20985,null,"See CPT",null,248.39099999999999,null,248.39099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C525)","v":1},519,20999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
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[{"$f":"SEARCH(Lookup!$B$2,C528)","v":1},522,21012,null,"See CPT",null,590.57999999999993,null,590.57999999999993,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C529)","v":1},523,21013,null,"See CPT",null,957.66599999999994,null,698.85299999999995,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C530)","v":1},524,21014,null,"See CPT",null,909.60900000000004,null,909.60900000000004,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C531)","v":1},525,21015,null,"See CPT",null,1220.5319999999999,null,1220.5319999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C532)","v":1},526,21016,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C533)","v":1},527,21025,null,"See CPT",null,1406.97,null,1157.4209999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C536)","v":1},530,21030,null,"See CPT",null,846.49799999999993,null,647.322,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C537)","v":1},531,21031,null,"See CPT",null,696.53699999999992,null,479.99099999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C538)","v":1},532,21032,null,"See CPT",null,693.06299999999999,null,468.411,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C539)","v":1},533,21034,null,"See CPT",null,2325.2639999999997,null,1989.444,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C540)","v":1},534,21040,null,"See CPT",null,859.23599999999999,null,652.53300000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C541)","v":1},535,21044,null,"See CPT",null,1518.1379999999999,null,1518.1379999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C542)","v":1},536,21045,null,"See CPT",null,2100.6120000000001,null,2100.6120000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C543)","v":1},537,21046,null,"See CPT",null,1771.1610000000001,null,1771.1610000000001,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C545)","v":1},539,21048,null,"See CPT",null,1792.5840000000001,null,1792.5840000000001,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C546)","v":1},540,21049,null,"See CPT",null,2134.7729999999997,null,2134.7729999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C547)","v":1},541,21050,null,"See CPT",null,1519.875,null,1519.875,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C548)","v":1},542,21060,null,"See CPT",null,1375.125,null,1375.125,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C549)","v":1},543,21070,null,"See CPT",null,1085.0459999999998,null,1085.0459999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C550)","v":1},544,21073,null,"See CPT",null,674.53499999999997,null,431.35500000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C551)","v":1},545,21076,null,"See CPT",null,1508.8739999999998,null,1225.164,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C554)","v":1},548,21080,null,"See CPT",null,2917.5810000000001,null,2302.683,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C555)","v":1},549,21081,null,"See CPT",null,2689.4549999999999,null,2108.7179999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C556)","v":1},550,21082,null,"See CPT",null,2460.75,null,1917.069,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C558)","v":1},552,21084,null,"See CPT",null,2685.402,null,2058.3449999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C562)","v":1},556,21088,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,0,0,0,0,0,null,"N"]
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[{"$f":"SEARCH(Lookup!$B$2,C564)","v":1},558,21100,null,"See CPT",null,1158.579,null,621.846,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C565)","v":1},559,21110,null,"See CPT",null,1568.511,null,1294.0650000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
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[{"$f":"SEARCH(Lookup!$B$2,C568)","v":1},562,21121,null,"See CPT",null,1155.684,null,954.19200000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C569)","v":1},563,21122,null,"See CPT",null,1349.07,null,1349.07,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C570)","v":1},564,21123,null,"See CPT",null,1525.665,null,1525.665,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C571)","v":1},565,21125,null,"See CPT",null,5147.3100000000004,null,1169.58,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C572)","v":1},566,21127,null,"See CPT",null,7657.8539999999994,null,1340.385,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C573)","v":1},567,21137,null,"See CPT",null,1300.434,null,1300.434,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C574)","v":1},568,21138,null,"See CPT",null,1580.67,null,1580.67,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C575)","v":1},569,21139,null,"See CPT",null,1915.3319999999999,null,1915.3319999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C577)","v":1},571,21142,null,"See CPT",null,2371.5839999999998,null,2371.5839999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C579)","v":1},573,21145,null,"See CPT",null,2682.5070000000001,null,2682.5070000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C580)","v":1},574,21146,null,"See CPT",null,2801.7809999999999,null,2801.7809999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C586)","v":1},580,21159,null,"See CPT",null,4553.2560000000003,null,4553.2560000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C587)","v":1},581,21160,null,"See CPT",null,4933.6589999999997,null,4933.6589999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C588)","v":1},582,21172,null,"See CPT",null,3628.0139999999997,null,3628.0139999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C589)","v":1},583,21175,null,"See CPT",null,3808.6619999999998,null,3808.6619999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C590)","v":1},584,21179,null,"See CPT",null,2621.1330000000003,null,2621.1330000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C591)","v":1},585,21180,null,"See CPT",null,2926.2660000000001,null,2926.2660000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C594)","v":1},588,21183,null,"See CPT",null,3956.3069999999998,null,3956.3069999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$B$2,C615)","v":1},609,21246,null,"See CPT",null,1471.818,null,1471.818,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C616)","v":1},610,21247,null,"See CPT",null,2736.3539999999998,null,2736.3539999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C617)","v":1},611,21248,null,"See CPT",null,1770.0029999999999,null,1392.4950000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C618)","v":1},612,21249,null,"See CPT",null,2389.5329999999999,null,1947.7560000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C619)","v":1},613,21255,null,"See CPT",null,2371.0050000000001,null,2371.0050000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C620)","v":1},614,21256,null,"See CPT",null,2138.826,null,2138.826,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C621)","v":1},615,21260,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C622)","v":1},616,21261,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C623)","v":1},617,21263,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C624)","v":1},618,21267,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C625)","v":1},619,21268,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C626)","v":1},620,21270,null,"See CPT",null,1785.636,null,1291.17,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C627)","v":1},621,21275,null,"See CPT",null,1460.817,null,1460.817,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C628)","v":1},622,21280,null,"See CPT",null,1009.197,null,1009.197,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C629)","v":1},623,21282,null,"See CPT",null,687.85199999999998,null,687.85199999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C630)","v":1},624,21295,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C631)","v":1},625,21296,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C632)","v":1},626,21299,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C633)","v":1},627,21310,null,"See CPT",null,243.18,null,46.32,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C634)","v":1},628,21315,null,"See CPT",null,530.36400000000003,null,275.02499999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C635)","v":1},629,21320,null,"See CPT",null,485.20200000000006,null,237.39,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C636)","v":1},630,21325,null,"See CPT",null,822.18,null,822.18,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C637)","v":1},631,21330,null,"See CPT",null,979.08899999999994,null,979.08899999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C638)","v":1},632,21335,null,"See CPT",null,1294.0650000000001,null,1294.0650000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C639)","v":1},633,21336,null,"See CPT",null,1176.528,null,1176.528,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C640)","v":1},634,21337,null,"See CPT",null,763.70099999999991,null,528.04799999999989,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C641)","v":1},635,21338,null,"See CPT",null,1230.954,null,1230.954,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C642)","v":1},636,21339,null,"See CPT",null,1384.3889999999999,null,1384.3889999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C643)","v":1},637,21340,null,"See CPT",null,1318.383,null,1318.383,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C644)","v":1},638,21343,null,"See CPT",null,1950.0719999999999,null,1950.0719999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C645)","v":1},639,21344,null,"See CPT",null,2463.0659999999998,null,2463.0659999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C646)","v":1},640,21345,null,"See CPT",null,1438.8150000000001,null,1121.5230000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C647)","v":1},641,21346,null,"See CPT",null,1845.2729999999999,null,1845.2729999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C648)","v":1},642,21347,null,"See CPT",null,1858.0110000000002,null,1858.0110000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C649)","v":1},643,21348,null,"See CPT",null,1911.8580000000002,null,1911.8580000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C650)","v":1},644,21355,null,"See CPT",null,809.44200000000001,null,578.42100000000005,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C651)","v":1},645,21356,null,"See CPT",null,912.50400000000002,null,664.11300000000006,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C652)","v":1},646,21360,null,"See CPT",null,920.61,null,920.61,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C653)","v":1},647,21365,null,"See CPT",null,1887.54,null,1887.54,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C654)","v":1},648,21366,null,"See CPT",null,2200.779,null,2200.779,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C655)","v":1},649,21385,null,"See CPT",null,1295.223,null,1295.223,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C656)","v":1},650,21386,null,"See CPT",null,1197.3719999999998,null,1197.3719999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C657)","v":1},651,21387,null,"See CPT",null,1350.8069999999998,null,1350.8069999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C658)","v":1},652,21390,null,"See CPT",null,1393.653,null,1393.653,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C659)","v":1},653,21395,null,"See CPT",null,1744.5269999999998,null,1744.5269999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C660)","v":1},654,21400,null,"See CPT",null,373.45499999999998,null,289.5,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C661)","v":1},655,21401,null,"See CPT",null,929.29500000000007,null,567.99900000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C662)","v":1},656,21406,null,"See CPT",null,1013.8290000000001,null,1013.8290000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C663)","v":1},657,21407,null,"See CPT",null,1115.7329999999999,null,1115.7329999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C664)","v":1},658,21408,null,"See CPT",null,1560.405,null,1560.405,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C665)","v":1},659,21421,null,"See CPT",null,1193.319,null,995.30100000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C666)","v":1},660,21422,null,"See CPT",null,1124.4180000000001,null,1124.4180000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C667)","v":1},661,21423,null,"See CPT",null,1405.8120000000001,null,1405.8120000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C668)","v":1},662,21431,null,"See CPT",null,1243.692,null,1243.692,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C669)","v":1},663,21432,null,"See CPT",null,1264.5360000000001,null,1264.5360000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C670)","v":1},664,21433,null,"See CPT",null,2983.0080000000003,null,2983.0080000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C671)","v":1},665,21435,null,"See CPT",null,2424.2729999999997,null,2424.2729999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C672)","v":1},666,21436,null,"See CPT",null,3502.95,null,3502.95,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C673)","v":1},667,21440,null,"See CPT",null,1226.9010000000001,null,979.08899999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C674)","v":1},668,21445,null,"See CPT",null,1438.2359999999999,null,1148.1569999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C675)","v":1},669,21450,null,"See CPT",null,1087.941,null,875.44799999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C676)","v":1},670,21451,null,"See CPT",null,1406.3909999999998,null,1165.5269999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C677)","v":1},671,21452,null,"See CPT",null,1404.654,null,844.18200000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C678)","v":1},672,21453,null,"See CPT",null,1987.1279999999999,null,1681.9949999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C679)","v":1},673,21454,null,"See CPT",null,847.65600000000006,null,847.65600000000006,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C680)","v":1},674,21461,null,"See CPT",null,3634.962,null,1906.6469999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C681)","v":1},675,21462,null,"See CPT",null,3939.5160000000001,null,2113.9289999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C682)","v":1},676,21465,null,"See CPT",null,1382.6519999999998,null,1382.6519999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C683)","v":1},677,21470,null,"See CPT",null,2013.7619999999999,null,2013.7619999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C684)","v":1},678,21480,null,"See CPT",null,249.54899999999998,null,53.268000000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C685)","v":1},679,21485,null,"See CPT",null,1773.4769999999999,null,1438.2359999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C686)","v":1},680,21490,null,"See CPT",null,1362.3869999999999,null,1362.3869999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C687)","v":1},681,21497,null,"See CPT",null,1296.9599999999998,null,1072.8869999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C688)","v":1},682,21499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C689)","v":1},683,21501,null,"See CPT",null,883.55399999999997,null,583.053,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C690)","v":1},684,21502,null,"See CPT",null,882.97500000000002,null,882.97500000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C691)","v":1},685,21510,null,"See CPT",null,788.59799999999996,null,788.59799999999996,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C692)","v":1},686,21550,null,"See CPT",null,493.88699999999994,null,273.28799999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C693)","v":1},687,21552,null,"See CPT",null,774.702,null,774.702,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C694)","v":1},688,21554,null,"See CPT",null,1266.8519999999999,null,1266.8519999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C695)","v":1},689,21555,null,"See CPT",null,784.54500000000007,null,536.73299999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C696)","v":1},690,21556,null,"See CPT",null,928.13700000000006,null,928.13700000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C697)","v":1},691,21557,null,"See CPT",null,1655.3609999999999,null,1655.3609999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C698)","v":1},692,21558,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C699)","v":1},693,21600,null,"See CPT",null,971.56200000000001,null,971.56200000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C700)","v":1},694,21601,null,"See CPT",null,2023.605,null,2023.605,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C701)","v":1},695,21602,null,"See CPT",null,2745.0389999999998,null,2745.0389999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C702)","v":1},696,21603,null,"See CPT",null,2987.64,null,2987.64,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C703)","v":1},697,21610,null,"See CPT",null,2064.1349999999998,null,2064.1349999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C704)","v":1},698,21615,null,"See CPT",null,1051.4639999999999,null,1051.4639999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C705)","v":1},699,21616,null,"See CPT",null,1210.6890000000001,null,1210.6890000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C706)","v":1},700,21620,null,"See CPT",null,881.23800000000006,null,881.23800000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C707)","v":1},701,21627,null,"See CPT",null,943.77,null,943.77,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C708)","v":1},702,21630,null,"See CPT",null,2054.8710000000001,null,2054.8710000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C709)","v":1},703,21632,null,"See CPT",null,2080.9259999999999,null,2080.9259999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C710)","v":1},704,21685,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C711)","v":1},705,21700,null,"See CPT",null,606.21299999999997,null,606.21299999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C712)","v":1},706,21705,null,"See CPT",null,902.66099999999994,null,902.66099999999994,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C713)","v":1},707,21720,null,"See CPT",null,919.452,null,919.452,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C714)","v":1},708,21725,null,"See CPT",null,944.34899999999993,null,944.34899999999993,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C715)","v":1},709,21740,null,"See CPT",null,1754.9489999999998,null,1754.9489999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C716)","v":1},710,21742,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C717)","v":1},711,21743,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C718)","v":1},712,21750,null,"See CPT",null,1161.4739999999999,null,1161.4739999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C719)","v":1},713,21811,null,"See CPT",null,1009.7760000000001,null,1009.7760000000001,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C720)","v":1},714,21812,null,"See CPT",null,1224.5849999999998,null,1224.5849999999998,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C721)","v":1},715,21813,null,"See CPT",null,1673.31,null,1673.31,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C722)","v":1},716,21820,null,"See CPT",null,265.18200000000002,null,260.55,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C723)","v":1},717,21825,null,"See CPT",null,948.98099999999999,null,948.98099999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C724)","v":1},718,21899,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C725)","v":1},719,21920,null,"See CPT",null,477.67500000000001,null,272.709,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C726)","v":1},720,21925,null,"See CPT",null,863.28899999999999,null,644.42700000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C727)","v":1},721,21930,null,"See CPT",null,895.71299999999997,null,632.84699999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C728)","v":1},722,21931,null,"See CPT",null,814.65300000000002,null,814.65300000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C729)","v":1},723,21932,null,"See CPT",null,1146.9989999999998,null,1146.9989999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C730)","v":1},724,21933,null,"See CPT",null,1274.9579999999999,null,1274.9579999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C731)","v":1},725,21935,null,"See CPT",null,1768.845,null,1768.845,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C732)","v":1},726,21936,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C733)","v":1},727,22010,null,"See CPT",null,1673.8889999999999,null,1673.8889999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C734)","v":1},728,22015,null,"See CPT",null,1641.4650000000001,null,1641.4650000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C735)","v":1},729,22100,null,"See CPT",null,1498.452,null,1498.452,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C736)","v":1},730,22101,null,"See CPT",null,1503.663,null,1503.663,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C737)","v":1},731,22102,null,"See CPT",null,1439.394,null,1439.394,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C738)","v":1},732,22103,null,"See CPT",null,238.548,null,238.548,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C739)","v":1},733,22110,null,"See CPT",null,1816.9019999999998,null,1816.9019999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C740)","v":1},734,22112,null,"See CPT",null,1948.3349999999998,null,1948.3349999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C741)","v":1},735,22114,null,"See CPT",null,1948.3349999999998,null,1948.3349999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C742)","v":1},736,22116,null,"See CPT",null,239.12699999999998,null,239.12699999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C743)","v":1},737,22206,null,"See CPT",null,4185.5910000000003,null,4185.5910000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C744)","v":1},738,22207,null,"See CPT",null,4102.7939999999999,null,4102.7939999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C745)","v":1},739,22208,null,"See CPT",null,994.72199999999998,null,994.72199999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C746)","v":1},740,22210,null,"See CPT",null,3084.3330000000001,null,3084.3330000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C747)","v":1},741,22212,null,"See CPT",null,2595.078,null,2595.078,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C748)","v":1},742,22214,null,"See CPT",null,2600.8679999999999,null,2600.8679999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C749)","v":1},743,22216,null,"See CPT",null,617.21399999999994,null,617.21399999999994,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C750)","v":1},744,22220,null,"See CPT",null,2788.4639999999999,null,2788.4639999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C751)","v":1},745,22222,null,"See CPT",null,3010.221,null,3010.221,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C752)","v":1},746,22224,null,"See CPT",null,2739.828,null,2739.828,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C753)","v":1},747,22226,null,"See CPT",null,613.16099999999994,null,613.16099999999994,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C754)","v":1},748,22310,null,"See CPT",null,541.36500000000001,null,517.04700000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C755)","v":1},749,22315,null,"See CPT",null,1551.72,null,1342.1219999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C756)","v":1},750,22318,null,"See CPT",null,2813.3610000000003,null,2813.3610000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C757)","v":1},751,22319,null,"See CPT",null,3129.4949999999999,null,3129.4949999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C758)","v":1},752,22325,null,"See CPT",null,2525.598,null,2525.598,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C759)","v":1},753,22326,null,"See CPT",null,2584.6559999999999,null,2584.6559999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C760)","v":1},754,22327,null,"See CPT",null,2630.9759999999997,null,2630.9759999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C761)","v":1},755,22328,null,"See CPT",null,475.93800000000005,null,475.93800000000005,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C762)","v":1},756,22505,null,"See CPT",null,224.65199999999999,null,224.65199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C763)","v":1},757,22510,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C764)","v":1},758,22511,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C765)","v":1},759,22512,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C766)","v":1},760,22513,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C767)","v":1},761,22514,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C768)","v":1},762,22515,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C769)","v":1},763,22526,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C770)","v":1},764,22527,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C771)","v":1},765,22532,null,"See CPT",null,3083.1749999999997,null,3083.1749999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C772)","v":1},766,22533,null,"See CPT",null,2848.6800000000003,null,2848.6800000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C773)","v":1},767,22534,null,"See CPT",null,609.10799999999995,null,609.10799999999995,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C774)","v":1},768,22548,null,"See CPT",null,3357.6210000000001,null,3357.6210000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C775)","v":1},769,22551,null,"See CPT",null,2918.16,null,2918.16,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C776)","v":1},770,22552,null,"See CPT",null,671.06099999999992,null,671.06099999999992,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C777)","v":1},771,22554,null,"See CPT",null,2166.6179999999999,null,2166.6179999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C778)","v":1},772,22556,null,"See CPT",null,2857.944,null,2857.944,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C779)","v":1},773,22558,null,"See CPT",null,2626.3440000000001,null,2626.3440000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C780)","v":1},774,22585,null,"See CPT",null,552.94500000000005,null,552.94500000000005,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C781)","v":1},775,22586,null,"See CPT",null,3474.5789999999997,null,3474.5789999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C782)","v":1},776,22590,null,"See CPT",null,2718.4050000000002,null,2718.4050000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C783)","v":1},777,22595,null,"See CPT",null,2595.6569999999997,null,2595.6569999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C784)","v":1},778,22600,null,"See CPT",null,2233.7819999999997,null,2233.7819999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C785)","v":1},779,22610,null,"See CPT",null,2198.4629999999997,null,2198.4629999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C786)","v":1},780,22612,null,"See CPT",null,2725.9319999999998,null,2725.9319999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C787)","v":1},781,22614,null,"See CPT",null,661.21799999999996,null,661.21799999999996,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C788)","v":1},782,22630,null,"See CPT",null,2712.6150000000002,null,2712.6150000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C789)","v":1},783,22632,null,"See CPT",null,541.36500000000001,null,541.36500000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C790)","v":1},784,22633,null,"See CPT",null,3171.183,null,3171.183,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C791)","v":1},785,22634,null,"See CPT",null,838.971,null,838.971,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C792)","v":1},786,22800,null,"See CPT",null,2338.5810000000001,null,2338.5810000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C793)","v":1},787,22802,null,"See CPT",null,3628.5929999999998,null,3628.5929999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C794)","v":1},788,22804,null,"See CPT",null,4168.8,null,4168.8,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C795)","v":1},789,22808,null,"See CPT",null,3127.7580000000003,null,3127.7580000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C796)","v":1},790,22810,null,"See CPT",null,3570.1139999999996,null,3570.1139999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C797)","v":1},791,22812,null,"See CPT",null,3786.0810000000001,null,3786.0810000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C798)","v":1},792,22818,null,"See CPT",null,3696.915,null,3696.915,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C799)","v":1},793,22819,null,"See CPT",null,4256.2290000000003,null,4256.2290000000003,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C800)","v":1},794,22830,null,"See CPT",null,1419.1290000000001,null,1419.1290000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C801)","v":1},795,22840,null,"See CPT",null,1285.3799999999999,null,1285.3799999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C802)","v":1},796,22841,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C803)","v":1},797,22842,null,"See CPT",null,1290.5909999999999,null,1290.5909999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C804)","v":1},798,22843,null,"See CPT",null,1380.336,null,1380.336,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C805)","v":1},799,22844,null,"See CPT",null,1674.4680000000001,null,1674.4680000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C806)","v":1},800,22845,null,"See CPT",null,1232.1120000000001,null,1232.1120000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C807)","v":1},801,22846,null,"See CPT",null,1279.5900000000001,null,1279.5900000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C808)","v":1},802,22847,null,"See CPT",null,1366.44,null,1366.44,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C809)","v":1},803,22848,null,"See CPT",null,609.6869999999999,null,609.6869999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C810)","v":1},804,22849,null,"See CPT",null,2246.52,null,2246.52,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C811)","v":1},805,22850,null,"See CPT",null,1270.326,null,1270.326,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C812)","v":1},806,22852,null,"See CPT",null,1222.269,null,1222.269,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C813)","v":1},807,22853,null,"See CPT",null,435.98700000000002,null,435.98700000000002,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C814)","v":1},808,22854,null,"See CPT",null,566.26199999999994,null,566.26199999999994,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C815)","v":1},809,22855,null,"See CPT",null,1911.2789999999998,null,1911.2789999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C816)","v":1},810,22856,null,"See CPT",null,2797.7280000000001,null,2797.7280000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C817)","v":1},811,22857,null,"See CPT",null,3042.645,null,3042.645,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C818)","v":1},812,22858,null,"See CPT",null,859.81499999999994,null,859.81499999999994,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C819)","v":1},813,22859,null,"See CPT",null,565.68299999999999,null,565.68299999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C820)","v":1},814,22861,null,"See CPT",null,3950.5170000000003,null,3950.5170000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C821)","v":1},815,22862,null,"See CPT",null,3953.4119999999998,null,3953.4119999999998,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C822)","v":1},816,22864,null,"See CPT",null,3529.5839999999998,null,3529.5839999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C823)","v":1},817,22865,null,"See CPT",null,3859.6139999999996,null,3859.6139999999996,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C824)","v":1},818,22867,null,"See CPT",null,1697.6279999999999,null,1697.6279999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C825)","v":1},819,22868,null,"See CPT",null,413.98500000000001,null,413.98500000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C826)","v":1},820,22869,null,"See CPT",null,772.38599999999997,null,772.38599999999997,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C827)","v":1},821,22870,null,"See CPT",null,209.01899999999998,null,209.01899999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C828)","v":1},822,22899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C829)","v":1},823,22900,null,"See CPT",null,979.66800000000012,null,979.66800000000012,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C830)","v":1},824,22901,null,"See CPT",null,1153.9469999999999,null,1153.9469999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C831)","v":1},825,22902,null,"See CPT",null,844.18200000000002,null,580.73699999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C832)","v":1},826,22903,null,"See CPT",null,764.28,null,764.28,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C833)","v":1},827,22904,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C834)","v":1},828,22905,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C835)","v":1},829,22999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C836)","v":1},830,23000,null,"See CPT",null,1031.1989999999998,null,634.005,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C837)","v":1},831,23020,null,"See CPT",null,1200.8459999999998,null,1200.8459999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C838)","v":1},832,23030,null,"See CPT",null,808.86300000000006,null,441.19799999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C839)","v":1},833,23031,null,"See CPT",null,782.22899999999993,null,379.245,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C840)","v":1},834,23035,null,"See CPT",null,1188.6870000000001,null,1188.6870000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C841)","v":1},835,23040,null,"See CPT",null,1249.482,null,1249.482,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C842)","v":1},836,23044,null,"See CPT",null,984.3,null,984.3,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C843)","v":1},837,23065,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C844)","v":1},838,23066,null,"See CPT",null,1045.095,null,643.84799999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C845)","v":1},839,23071,null,"See CPT",null,730.11899999999991,null,730.11899999999991,null,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C846)","v":1},840,23073,null,"See CPT",null,1206.636,null,1206.636,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C847)","v":1},841,23075,null,"See CPT",null,931.61099999999999,null,572.63099999999997,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C848)","v":1},842,23076,null,"See CPT",null,942.0329999999999,null,942.0329999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C849)","v":1},843,23077,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C850)","v":1},844,23078,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C851)","v":1},845,23100,null,"See CPT",null,885.87,null,885.87,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C852)","v":1},846,23101,null,"See CPT",null,800.75699999999995,null,800.75699999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C853)","v":1},847,23105,null,"See CPT",null,1120.365,null,1120.365,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C854)","v":1},848,23106,null,"See CPT",null,878.92199999999991,null,878.92199999999991,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C855)","v":1},849,23107,null,"See CPT",null,1153.9469999999999,null,1153.9469999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C856)","v":1},850,23120,null,"See CPT",null,1026.567,null,1026.567,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C857)","v":1},851,23125,null,"See CPT",null,1236.165,null,1236.165,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C858)","v":1},852,23130,null,"See CPT",null,1080.9930000000002,null,1080.9930000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C859)","v":1},853,23140,null,"See CPT",null,970.40400000000011,null,970.40400000000011,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C860)","v":1},854,23145,null,"See CPT",null,1212.4259999999999,null,1212.4259999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C861)","v":1},855,23146,null,"See CPT",null,1089.6779999999999,null,1089.6779999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C862)","v":1},856,23150,null,"See CPT",null,1148.7359999999999,null,1148.7359999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C863)","v":1},857,23155,null,"See CPT",null,1387.8629999999998,null,1387.8629999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C864)","v":1},858,23156,null,"See CPT",null,1184.0549999999998,null,1184.0549999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C865)","v":1},859,23170,null,"See CPT",null,986.61599999999987,null,986.61599999999987,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C866)","v":1},860,23172,null,"See CPT",null,996.45900000000006,null,996.45900000000006,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C867)","v":1},861,23174,null,"See CPT",null,1331.1209999999999,null,1331.1209999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C868)","v":1},862,23180,null,"See CPT",null,1156.2629999999999,null,1156.2629999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C869)","v":1},863,23182,null,"See CPT",null,1171.896,null,1171.896,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C870)","v":1},864,23184,null,"See CPT",null,1288.854,null,1288.854,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C871)","v":1},865,23190,null,"See CPT",null,1005.7230000000001,null,1005.7230000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C872)","v":1},866,23195,null,"See CPT",null,1299.855,null,1299.855,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C873)","v":1},867,23200,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C874)","v":1},868,23210,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C875)","v":1},869,23220,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C876)","v":1},870,23330,null,"See CPT",null,545.99699999999996,null,292.39499999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C877)","v":1},871,23333,null,"See CPT",null,828.54899999999998,null,828.54899999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C878)","v":1},872,23334,null,"See CPT",null,1844.694,null,1844.694,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C879)","v":1},873,23335,null,"See CPT",null,2187.462,null,2187.462,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C880)","v":1},874,23350,null,"See CPT",null,300.50100000000003,null,85.691999999999993,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C881)","v":1},875,23395,null,"See CPT",null,2216.4119999999998,null,2216.4119999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C882)","v":1},876,23397,null,"See CPT",null,1955.8620000000001,null,1955.8620000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C883)","v":1},877,23400,null,"See CPT",null,1687.7849999999999,null,1687.7849999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C884)","v":1},878,23405,null,"See CPT",null,1081.5719999999999,null,1081.5719999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C885)","v":1},879,23406,null,"See CPT",null,1322.4359999999999,null,1322.4359999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C886)","v":1},880,23410,null,"See CPT",null,1423.761,null,1423.761,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C887)","v":1},881,23412,null,"See CPT",null,1479.924,null,1479.924,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C888)","v":1},882,23415,null,"See CPT",null,1216.479,null,1216.479,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C889)","v":1},883,23420,null,"See CPT",null,1690.1010000000001,null,1690.1010000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C890)","v":1},884,23430,null,"See CPT",null,1295.8019999999999,null,1295.8019999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C891)","v":1},885,23440,null,"See CPT",null,1313.172,null,1313.172,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C892)","v":1},886,23450,null,"See CPT",null,1639.1489999999999,null,1639.1489999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C893)","v":1},887,23455,null,"See CPT",null,1719.0509999999999,null,1719.0509999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C894)","v":1},888,23460,null,"See CPT",null,1887.54,null,1887.54,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C895)","v":1},889,23462,null,"See CPT",null,1847.0099999999998,null,1847.0099999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C896)","v":1},890,23465,null,"See CPT",null,1935.018,null,1935.018,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C897)","v":1},891,23466,null,"See CPT",null,1937.3340000000001,null,1937.3340000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C898)","v":1},892,23470,null,"See CPT",null,2073.9780000000001,null,2073.9780000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C899)","v":1},893,23472,null,"See CPT",null,2494.9110000000001,null,2494.9110000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C900)","v":1},894,23473,null,"See CPT",null,2780.9369999999999,null,2780.9369999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C901)","v":1},895,23474,null,"See CPT",null,2997.4830000000002,null,2997.4830000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C902)","v":1},896,23480,null,"See CPT",null,1424.9189999999999,null,1424.9189999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C903)","v":1},897,23485,null,"See CPT",null,1643.7809999999999,null,1643.7809999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C904)","v":1},898,23490,null,"See CPT",null,1493.82,null,1493.82,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C905)","v":1},899,23491,null,"See CPT",null,1760.739,null,1760.739,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C906)","v":1},900,23500,null,"See CPT",null,396.036,null,404.142,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C907)","v":1},901,23505,null,"See CPT",null,635.74199999999996,null,589.42200000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C908)","v":1},902,23515,null,"See CPT",null,1254.114,null,1254.114,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C909)","v":1},903,23520,null,"See CPT",null,427.88099999999997,null,423.24899999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C910)","v":1},904,23525,null,"See CPT",null,702.90600000000006,null,640.95299999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C911)","v":1},905,23530,null,"See CPT",null,1006.3019999999999,null,1006.3019999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C912)","v":1},906,23532,null,"See CPT",null,1093.731,null,1093.731,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C913)","v":1},907,23540,null,"See CPT",null,420.93299999999999,null,416.30099999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C914)","v":1},908,23545,null,"See CPT",null,621.846,null,556.99799999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C915)","v":1},909,23550,null,"See CPT",null,999.35400000000004,null,999.35400000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C916)","v":1},910,23552,null,"See CPT",null,1141.788,null,1141.788,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C917)","v":1},911,23570,null,"See CPT",null,417.459,null,430.19699999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C918)","v":1},912,23575,null,"See CPT",null,725.48699999999997,null,669.32400000000007,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C919)","v":1},913,23585,null,"See CPT",null,1689.5219999999999,null,1689.5219999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C920)","v":1},914,23600,null,"See CPT",null,594.63299999999992,null,560.47199999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C921)","v":1},915,23605,null,"See CPT",null,835.49699999999996,null,754.4369999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C922)","v":1},916,23615,null,"See CPT",null,1533.771,null,1533.771,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C923)","v":1},917,23616,null,"See CPT",null,2133.0360000000001,null,2133.0360000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C924)","v":1},918,23620,null,"See CPT",null,482.30700000000002,null,462.04200000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C925)","v":1},919,23625,null,"See CPT",null,678.58799999999997,null,621.26700000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C926)","v":1},920,23630,null,"See CPT",null,1356.597,null,1356.597,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C927)","v":1},921,23650,null,"See CPT",null,579.57899999999995,null,521.67899999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C928)","v":1},922,23655,null,"See CPT",null,719.697,null,719.697,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C929)","v":1},923,23660,null,"See CPT",null,1023.6719999999999,null,1023.6719999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C930)","v":1},924,23665,null,"See CPT",null,765.43799999999999,null,702.90600000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C931)","v":1},925,23670,null,"See CPT",null,1511.19,null,1511.19,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C932)","v":1},926,23675,null,"See CPT",null,975.03599999999994,null,878.92199999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C933)","v":1},927,23680,null,"See CPT",null,1607.883,null,1607.883,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C934)","v":1},928,23700,null,"See CPT",null,341.03099999999995,null,341.03099999999995,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C935)","v":1},929,23800,null,"See CPT",null,1779.8459999999998,null,1779.8459999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C936)","v":1},930,23802,null,"See CPT",null,2217.5699999999997,null,2217.5699999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C937)","v":1},931,23900,null,"See CPT",null,2389.5329999999999,null,2389.5329999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C938)","v":1},932,23920,null,"See CPT",null,1943.124,null,1943.124,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C939)","v":1},933,23921,null,"See CPT",null,824.49599999999998,null,824.49599999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C940)","v":1},934,23929,null,"See CPT",null,0,null,0,null,"000",0,0,0,0,2,0,2,1,1,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C941)","v":1},935,23930,null,"See CPT",null,664.11300000000006,null,375.19200000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C942)","v":1},936,23931,null,"See CPT",null,559.89300000000003,null,281.39400000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C943)","v":1},937,23935,null,"See CPT",null,895.13400000000001,null,895.13400000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C944)","v":1},938,24000,null,"See CPT",null,834.91800000000001,null,834.91800000000001,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C945)","v":1},939,24006,null,"See CPT",null,1239.06,null,1239.06,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C946)","v":1},940,24065,null,"See CPT",null,472.464,null,285.447,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C947)","v":1},941,24066,null,"See CPT",null,1131.9449999999999,null,732.43500000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C948)","v":1},942,24071,null,"See CPT",null,706.38,null,706.38,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C949)","v":1},943,24073,null,"See CPT",null,1202.0040000000001,null,1202.0040000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C950)","v":1},944,24075,null,"See CPT",null,966.351,null,574.947,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C951)","v":1},945,24076,null,"See CPT",null,946.66500000000008,null,946.66500000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C952)","v":1},946,24077,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C953)","v":1},947,24079,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C954)","v":1},948,24100,null,"See CPT",null,736.48800000000006,null,736.48800000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C955)","v":1},949,24101,null,"See CPT",null,882.39599999999996,null,882.39599999999996,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C956)","v":1},950,24102,null,"See CPT",null,1078.6769999999999,null,1078.6769999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C957)","v":1},951,24105,null,"See CPT",null,632.84699999999998,null,632.84699999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C958)","v":1},952,24110,null,"See CPT",null,1014.9870000000001,null,1014.9870000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C959)","v":1},953,24115,null,"See CPT",null,1284.222,null,1284.222,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C960)","v":1},954,24116,null,"See CPT",null,1493.82,null,1493.82,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C961)","v":1},955,24120,null,"See CPT",null,932.19,null,932.19,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C962)","v":1},956,24125,null,"See CPT",null,1087.941,null,1087.941,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C963)","v":1},957,24126,null,"See CPT",null,1135.4189999999999,null,1135.4189999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C964)","v":1},958,24130,null,"See CPT",null,893.976,null,893.976,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C965)","v":1},959,24134,null,"See CPT",null,1301.0129999999999,null,1301.0129999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C966)","v":1},960,24136,null,"See CPT",null,1104.732,null,1104.732,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C967)","v":1},961,24138,null,"See CPT",null,1200.2670000000001,null,1200.2670000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C968)","v":1},962,24140,null,"See CPT",null,1225.7430000000002,null,1225.7430000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C969)","v":1},963,24145,null,"See CPT",null,1039.3049999999998,null,1039.3049999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C970)","v":1},964,24147,null,"See CPT",null,1101.837,null,1101.837,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C971)","v":1},965,24149,null,"See CPT",null,2042.133,null,2042.133,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C972)","v":1},966,24150,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C973)","v":1},967,24152,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C974)","v":1},968,24155,null,"See CPT",null,1478.7659999999998,null,1478.7659999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C975)","v":1},969,24160,null,"See CPT",null,2170.6710000000003,null,2170.6710000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C976)","v":1},970,24164,null,"See CPT",null,1252.9559999999999,null,1252.9559999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C977)","v":1},971,24200,null,"See CPT",null,402.40499999999997,null,248.96999999999997,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C978)","v":1},972,24201,null,"See CPT",null,997.0379999999999,null,638.05799999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C979)","v":1},973,24220,null,"See CPT",null,351.45300000000003,null,114.063,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C980)","v":1},974,24300,null,"See CPT",null,766.596,null,766.596,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C981)","v":1},975,24301,null,"See CPT",null,1305.645,null,1305.645,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C982)","v":1},976,24305,null,"See CPT",null,1011.5129999999999,null,1011.5129999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C983)","v":1},977,24310,null,"See CPT",null,829.70699999999999,null,829.70699999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C984)","v":1},978,24320,null,"See CPT",null,1357.1759999999999,null,1357.1759999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C985)","v":1},979,24330,null,"See CPT",null,1250.6400000000001,null,1250.6400000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C986)","v":1},980,24331,null,"See CPT",null,1365.8609999999999,null,1365.8609999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C987)","v":1},981,24332,null,"See CPT",null,1075.7819999999999,null,1075.7819999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C988)","v":1},982,24340,null,"See CPT",null,1080.9930000000002,null,1080.9930000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C989)","v":1},983,24341,null,"See CPT",null,1302.1709999999998,null,1302.1709999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C990)","v":1},984,24342,null,"See CPT",null,1347.912,null,1347.912,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C991)","v":1},985,24343,null,"See CPT",null,1244.8499999999999,null,1244.8499999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C992)","v":1},986,24344,null,"See CPT",null,1896.8039999999999,null,1896.8039999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C993)","v":1},987,24345,null,"See CPT",null,1236.7439999999999,null,1236.7439999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C994)","v":1},988,24346,null,"See CPT",null,1914.7529999999999,null,1914.7529999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C995)","v":1},989,24357,null,"See CPT",null,737.06700000000001,null,737.06700000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C996)","v":1},990,24358,null,"See CPT",null,922.92599999999993,null,922.92599999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C997)","v":1},991,24359,null,"See CPT",null,1153.9469999999999,null,1153.9469999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C998)","v":1},992,24360,null,"See CPT",null,1566.7739999999999,null,1566.7739999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C999)","v":1},993,24361,null,"See CPT",null,1746.2639999999999,null,1746.2639999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1000)","v":1},994,24362,null,"See CPT",null,1837.1669999999999,null,1837.1669999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1016)","v":1},1010,24515,null,"See CPT",null,1529.1389999999999,null,1529.1389999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1023)","v":1},1017,24560,null,"See CPT",null,596.37,null,525.73199999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1038)","v":1},1032,24640,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C1070)","v":1},1064,25075,null,"See CPT",null,944.34899999999993,null,551.78699999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1081)","v":1},1075,25111,null,"See CPT",null,570.89400000000001,null,570.89400000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1095)","v":1},1089,25151,null,"See CPT",null,1021.356,null,1021.356,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1124)","v":1},1118,25335,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C1142)","v":1},1136,25426,null,"See CPT",null,1943.703,null,1943.703,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1148)","v":1},1142,25443,null,"See CPT",null,1366.44,null,1366.44,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1171)","v":1},1165,25575,null,"See CPT",null,1571.4059999999999,null,1571.4059999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1185)","v":1},1179,25651,null,"See CPT",null,860.39399999999989,null,860.39399999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1218)","v":1},1212,26030,null,"See CPT",null,856.34099999999989,null,856.34099999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1228)","v":1},1222,26080,null,"See CPT",null,700.58999999999992,null,700.58999999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1243)","v":1},1237,26140,null,"See CPT",null,888.76499999999999,null,888.76499999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1268)","v":1},1262,26372,null,"See CPT",null,1644.9390000000001,null,1644.9390000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1289)","v":1},1283,26455,null,"See CPT",null,808.86300000000006,null,808.86300000000006,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1297)","v":1},1291,26480,null,"See CPT",null,1413.3389999999999,null,1413.3389999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1332)","v":1},1326,26556,null,"See CPT",null,5914.4850000000006,null,5914.4850000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1340)","v":1},1334,26587,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C1356)","v":1},1350,26676,null,"See CPT",null,899.1869999999999,null,899.1869999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1387)","v":1},1381,26862,null,"See CPT",null,1362.3869999999999,null,1362.3869999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1399)","v":1},1393,27005,null,"See CPT",null,1250.6400000000001,null,1250.6400000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1416)","v":1},1410,27054,null,"See CPT",null,1199.1089999999999,null,1199.1089999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1436)","v":1},1430,27095,null,"See CPT",null,588.84299999999996,null,141.85500000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1445)","v":1},1439,27122,null,"See CPT",null,1907.8050000000001,null,1907.8050000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1479)","v":1},1473,27226,null,"See CPT",null,1826.7449999999999,null,1826.7449999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1488)","v":1},1482,27244,null,"See CPT",null,2120.2979999999998,null,2120.2979999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1513)","v":1},1507,27299,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C1521)","v":1},1515,27324,null,"See CPT",null,712.17000000000007,null,712.17000000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1542)","v":1},1536,27358,null,"See CPT",null,468.411,null,468.411,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1564)","v":1},1558,27409,null,"See CPT",null,1677.3629999999998,null,1677.3629999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1585)","v":1},1579,27446,null,"See CPT",null,1991.181,null,1991.181,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1607)","v":1},1601,27498,null,"See CPT",null,1146.42,null,1146.42,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1614)","v":1},1608,27507,null,"See CPT",null,1672.731,null,1672.731,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1644)","v":1},1638,27592,null,"See CPT",null,1150.473,null,1150.473,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1661)","v":1},1655,27615,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C1668)","v":1},1662,27630,null,"See CPT",null,990.66899999999998,null,628.21499999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1690)","v":1},1684,27680,null,"See CPT",null,731.27700000000004,null,731.27700000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1711)","v":1},1705,27722,null,"See CPT",null,1553.4569999999999,null,1553.4569999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1733)","v":1},1727,27780,null,"See CPT",null,553.524,null,506.625,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1740)","v":1},1734,27810,null,"See CPT",null,836.65499999999997,null,750.38400000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1772)","v":1},1766,27899,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C1787)","v":1},1781,28045,null,"See CPT",null,865.02599999999995,null,599.26499999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1796)","v":1},1790,28070,null,"See CPT",null,941.45400000000006,null,609.6869999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1830)","v":1},1824,28190,null,"See CPT",null,455.673,null,231.6,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1839)","v":1},1833,28225,null,"See CPT",null,752.69999999999993,null,458.56799999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1859)","v":1},1853,28292,null,"See CPT",null,1267.431,null,831.44399999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1876)","v":1},1870,28315,null,"See CPT",null,864.447,null,565.68299999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1888)","v":1},1882,28420,null,"See CPT",null,2256.9419999999996,null,2256.9419999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1919)","v":1},1913,28600,null,"See CPT",null,387.351,null,326.55599999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1935)","v":1},1929,28735,null,"See CPT",null,1347.912,null,1347.912,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C1943)","v":1},1937,28810,null,"See CPT",null,735.32999999999993,null,735.32999999999993,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1978)","v":1},1972,29425,null,"See CPT",null,132.01199999999997,null,93.798000000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C1985)","v":1},1979,29520,null,"See CPT",null,63.690000000000005,null,31.845000000000002,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2004)","v":1},1998,29807,null,"See CPT",null,1792.5840000000001,null,1792.5840000000001,null,"090",0.1,0.69,0.21,0,3,1,1,1,0,29805,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2032)","v":1},2026,29860,null,"See CPT",null,1120.365,null,1120.365,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2047)","v":1},2041,29880,null,"See CPT",null,980.82600000000002,null,980.82600000000002,null,"090",0.1,0.69,0.21,0,3,1,0,1,0,29870,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2057)","v":1},2051,29891,null,"See CPT",null,1165.5269999999998,null,1165.5269999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2071)","v":1},2065,29907,null,"See CPT",null,1522.1909999999998,null,1522.1909999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2104)","v":1},2098,30465,null,"See CPT",null,1858.0110000000002,null,1858.0110000000002,null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2108)","v":1},2102,30545,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2133)","v":1},2127,31075,null,"See CPT",null,1505.3999999999999,null,1505.3999999999999,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2151)","v":1},2145,31239,null,"See CPT",null,1058.412,null,1058.412,null,"010",0.1,0.8,0.1,0,3,1,0,0,0,31231,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2180)","v":1},2174,31375,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2194)","v":1},2188,31515,null,"See CPT",null,396.036,null,191.649,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2205)","v":1},2199,31540,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,31525,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2230)","v":1},2224,31592,null,"See CPT",null,3078.5430000000001,null,3078.5430000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2255)","v":1},2249,31635,null,"See CPT",null,522.83699999999999,null,300.50100000000003,null,"000",0,0,0,0,3,0,1,0,0,31622,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2273)","v":1},2267,31717,null,"See CPT",null,534.41700000000003,null,181.80600000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2279)","v":1},2273,31760,null,"See CPT",null,2339.16,null,2339.16,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2302)","v":1},2296,32140,null,"See CPT",null,1688.364,null,1688.364,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2322)","v":1},2316,32488,null,"See CPT",null,4048.9470000000001,null,4048.9470000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2331)","v":1},2325,32550,null,"See CPT",null,1523.9279999999999,null,349.137,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2359)","v":1},2353,32663,null,"See CPT",null,2372.7419999999997,null,2372.7419999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2378)","v":1},2372,32852,null,"See CPT",null,6050.55,null,6050.55,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2402)","v":1},2396,33130,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2407)","v":1},2401,33206,null,"See CPT",null,790.91399999999999,null,790.91399999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2426)","v":1},2420,33227,null,"See CPT",null,589.42200000000003,null,589.42200000000003,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2450)","v":1},2444,33261,null,"See CPT",null,2729.4059999999999,null,2729.4059999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2475)","v":1},2469,33362,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,2,1,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2487)","v":1},2481,33406,null,"See CPT",null,4872.8639999999996,null,4872.8639999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2500)","v":1},2494,33425,null,"See CPT",null,4619.2619999999997,null,4619.2619999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2530)","v":1},2524,33513,null,"See CPT",null,4205.8559999999998,null,4205.8559999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2547)","v":1},2541,33572,null,"See CPT",null,387.351,null,387.351,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2554)","v":1},2548,33612,null,"See CPT",null,3385.413,null,3385.413,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2576)","v":1},2570,33697,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2591)","v":1},2585,33750,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2623)","v":1},2617,33852,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2634)","v":1},2628,33881,null,"See CPT",null,2577.1289999999999,null,2577.1289999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,2,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2648)","v":1},2642,33926,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2677)","v":1},2671,33968,null,"See CPT",null,56.741999999999997,null,56.741999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2695)","v":1},2689,33987,null,"See CPT",null,349.71600000000001,null,349.71600000000001,null,"000",0,0,0,0,0,0,0,1,1,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2702)","v":1},2696,33995,null,"See CPT",null,617.79300000000001,null,617.79300000000001,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C2719)","v":1},2713,34510,null,"See CPT",null,1708.6290000000001,null,1708.6290000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2745)","v":1},2739,34831,null,"See CPT",null,3212.2919999999999,null,3212.2919999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2762)","v":1},2756,35013,null,"See CPT",null,2123.7719999999999,null,2123.7719999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2774)","v":1},2768,35121,null,"See CPT",null,2636.7660000000001,null,2636.7660000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2805)","v":1},2799,35281,null,"See CPT",null,2718.4050000000002,null,2718.4050000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2821)","v":1},2815,35371,null,"See CPT",null,1372.23,null,1372.23,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2842)","v":1},2836,35533,null,"See CPT",null,2514.5969999999998,null,2514.5969999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2850)","v":1},2844,35558,null,"See CPT",null,2059.5030000000002,null,2059.5030000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2866)","v":1},2860,35621,null,"See CPT",null,1838.325,null,1838.325,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2893)","v":1},2887,35691,null,"See CPT",null,1582.4069999999999,null,1582.4069999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2909)","v":1},2903,35879,null,"See CPT",null,1549.9829999999999,null,1549.9829999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C2922)","v":1},2916,36012,null,"See CPT",null,1650.1499999999999,null,292.97399999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2947)","v":1},2941,36252,null,"See CPT",null,2807.5709999999999,null,607.37099999999998,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C2970)","v":1},2964,36468,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2990)","v":1},2984,36555,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C2994)","v":1},2988,36560,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3019)","v":1},3013,36595,null,"See CPT",null,1163.211,null,308.60699999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3037)","v":1},3031,36825,null,"See CPT",null,1345.5959999999998,null,1345.5959999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3066)","v":1},3060,37188,null,"See CPT",null,3014.2739999999999,null,467.83199999999999,null,"000",0,0,0,0,0,1,1,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3074)","v":1},3068,37212,null,"See CPT",null,567.99900000000002,null,567.99900000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3095)","v":1},3089,37234,null,"See CPT",null,7497.4710000000005,null,481.149,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3117)","v":1},3111,37607,null,"See CPT",null,638.05799999999999,null,638.05799999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3138)","v":1},3132,37799,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C3160)","v":1},3154,38222,null,"See CPT",null,321.92399999999998,null,132.59100000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3167)","v":1},3161,38300,null,"See CPT",null,621.846,null,365.928,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3192)","v":1},3186,38724,null,"See CPT",null,2526.1770000000001,null,2526.1770000000001,null,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3202)","v":1},3196,38792,null,"See CPT",null,148.803,null,55.583999999999996,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3217)","v":1},3211,39545,null,"See CPT",null,1530.876,null,1530.876,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3245)","v":1},3239,40814,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3264)","v":1},3258,41010,null,"See CPT",null,417.459,null,198.018,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3282)","v":1},3276,41140,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3293)","v":1},3287,41530,null,"See CPT",null,1878.2759999999998,null,712.74900000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3325)","v":1},3319,42210,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3340)","v":1},3334,42330,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3349)","v":1},3343,42420,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3365)","v":1},3359,42700,null,"See CPT",null,357.822,null,241.44299999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3392)","v":1},3386,42950,null,"See CPT",null,1483.3979999999999,null,1483.3979999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3412)","v":1},3406,43117,null,"See CPT",null,5524.8180000000002,null,5524.8180000000002,null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3419)","v":1},3413,43135,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3453)","v":1},3447,43238,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,43235,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3462)","v":1},3456,43247,null,"See CPT",null,706.38,null,301.65899999999999,null,"000",0,0,0,0,3,0,1,0,0,43235,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3477)","v":1},3471,43264,null,"See CPT",null,619.53,null,619.53,null,"000",0,0,0,0,3,0,1,0,0,43260,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3509)","v":1},3503,43331,null,"See CPT",null,2283.576,null,2283.576,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3514)","v":1},3508,43336,null,"See CPT",null,2465.3820000000001,null,2465.3820000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3538)","v":1},3532,43520,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3557)","v":1},3551,43652,null,"See CPT",null,1323.0150000000001,null,1323.0150000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3567)","v":1},3561,43762,null,"See CPT",null,441.77699999999999,null,63.111000000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3600)","v":1},3594,43999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C3610)","v":1},3604,44110,null,"See CPT",null,1461.396,null,1461.396,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3624)","v":1},3618,44139,null,"See CPT",null,204.38699999999997,null,204.38699999999997,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3657)","v":1},3651,44310,null,"See CPT",null,1781.0040000000001,null,1781.0040000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3664)","v":1},3658,44345,null,"See CPT",null,1801.848,null,1801.848,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3685)","v":1},3679,44386,null,"See CPT",null,588.84299999999996,null,151.69800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3707)","v":1},3701,44625,null,"See CPT",null,1730.0519999999999,null,1730.0519999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3728)","v":1},3722,44960,null,"See CPT",null,1508.2950000000001,null,1508.2950000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3736)","v":1},3730,45110,null,"See CPT",null,3135.8639999999996,null,3135.8639999999996,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3765)","v":1},3759,45327,null,"See CPT",null,199.755,null,199.755,null,"000",0,0,0,0,3,0,1,0,0,45300,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3783)","v":1},3777,45379,null,"See CPT",null,793.2299999999999,null,406.45799999999997,null,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3789)","v":1},3783,45386,null,"See CPT",null,1164.9480000000001,null,360.71700000000004,null,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3812)","v":1},3806,45800,null,"See CPT",null,2196.7259999999997,null,2196.7259999999997,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3832)","v":1},3826,46220,null,"See CPT",null,451.62,null,210.17699999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3855)","v":1},3849,46608,null,"See CPT",null,551.78699999999992,null,144.17100000000002,null,"000",0,0,0,0,3,0,1,0,0,46600,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3875)","v":1},3869,46748,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3884)","v":1},3878,46916,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C3905)","v":1},3899,47133,null,"See CPT",null,5035.1665478400009,null,5035.16654784,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C3917)","v":1},3911,47360,null,"See CPT",null,3230.241,null,3230.241,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3952)","v":1},3946,47555,null,"See CPT",null,550.62900000000002,null,550.62900000000002,null,"000",0,0,0,0,3,0,1,0,0,47552,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3960)","v":1},3954,47605,null,"See CPT",null,1939.6499999999999,null,1939.6499999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C3981)","v":1},3975,47999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,1,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C3997)","v":1},3991,48155,null,"See CPT",null,3142.8119999999999,null,3142.8119999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4010)","v":1},4004,48554,null,"See CPT",null,4477.4070000000002,null,4477.4070000000002,null,"090",0.09,0.81,0.1,0,2,0,2,2,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4040)","v":1},4034,49327,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4057)","v":1},4051,49427,null,"See CPT",null,64.847999999999999,null,64.847999999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4083)","v":1},4077,49550,null,"See CPT",null,998.19599999999991,null,998.19599999999991,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4100)","v":1},4094,49605,null,"See CPT",null,8401.8690000000006,null,8401.8690000000006,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4107)","v":1},4101,49653,null,"See CPT",null,1606.146,null,1606.146,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C4129)","v":1},4123,50120,null,"See CPT",null,1650.729,null,1650.729,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4144)","v":1},4138,50300,null,"See CPT",null,3876.5107180800001,null,3876.5107180800001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4158)","v":1},4152,50385,null,"See CPT",null,2054.2919999999999,null,373.45499999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4179)","v":1},4173,50540,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,2,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4211)","v":1},4205,50660,null,"See CPT",null,1983.075,null,1983.075,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4226)","v":1},4220,50728,null,"See CPT",null,1273.8,null,1273.8,null,"090",0.08,0.83,0.09,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4248)","v":1},4242,50945,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4255)","v":1},4249,50957,null,"See CPT",null,764.28,null,608.529,null,"000",0,0,0,0,3,1,0,0,0,50951,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4272)","v":1},4266,51102,null,"See CPT",null,441.19799999999998,null,250.12800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4298)","v":1},4292,51715,null,"See CPT",null,668.16599999999994,null,345.66299999999995,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4315)","v":1},4309,51736,null,"See CPT",null,23.738999999999997,null,23.738999999999997,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4327)","v":1},4321,51792,null,"See CPT",null,504.88800000000003,null,504.88800000000003,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4358)","v":1},4352,52224,null,"See CPT",null,1521.0329999999999,null,349.71600000000001,null,"000",0,0,0,0,3,0,1,0,0,52000,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4374)","v":1},4368,52290,null,"See CPT",null,419.77499999999998,null,419.77499999999998,null,"000",0,0,0,0,3,2,1,0,0,52000,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4395)","v":1},4389,52352,null,"See CPT",null,608.529,null,608.529,null,"000",0,0,0,0,3,1,1,0,0,52351,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4403)","v":1},4397,52442,null,"See CPT",null,1891.5930000000001,null,86.85,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4424)","v":1},4418,53220,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4443)","v":1},4437,53444,null,"See CPT",null,1382.0730000000001,null,1382.0730000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4453)","v":1},4447,53505,null,"See CPT",null,851.12999999999988,null,851.12999999999988,null,"090",0.08,0.83,0.09,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4480)","v":1},4474,54105,null,"See CPT",null,496.20300000000003,null,371.71799999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4500)","v":1},4494,54235,null,"See CPT",null,157.488,null,126.80099999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4523)","v":1},4517,54360,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4543)","v":1},4537,54450,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4547)","v":1},4541,54520,null,"See CPT",null,575.52599999999995,null,575.52599999999995,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4572)","v":1},4566,55000,null,"See CPT",null,217.125,null,146.48699999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4590)","v":1},4584,55540,null,"See CPT",null,961.1400000000001,null,961.1400000000001,null,"090",0.1,0.8,0.1,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4601)","v":1},4595,55725,null,"See CPT",null,1042.779,null,1042.779,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4627)","v":1},4621,56440,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4648)","v":1},4642,56820,null,"See CPT",null,221.75700000000001,null,147.066,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4669)","v":1},4663,57156,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4675)","v":1},4669,57220,null,"See CPT",null,612.00300000000004,null,612.00300000000004,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4698)","v":1},4692,57307,null,"See CPT",null,1850.4839999999999,null,1850.4839999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4712)","v":1},4706,57426,null,"See CPT",null,1531.4549999999999,null,1531.4549999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4745)","v":1},4739,58152,null,"See CPT",null,2175.3029999999999,null,2175.3029999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4755)","v":1},4749,58275,null,"See CPT",null,1742.79,null,1742.79,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4770)","v":1},4764,58350,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4798)","v":1},4792,58572,null,"See CPT",null,1815.165,null,1815.165,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4817)","v":1},4811,58720,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4822)","v":1},4816,58770,null,"See CPT",null,1518.7170000000001,null,1518.7170000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4846)","v":1},4840,59000,null,"See CPT",null,213.072,null,137.22300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4859)","v":1},4853,59070,null,"See CPT",null,713.32799999999997,null,530.94299999999998,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4893)","v":1},4887,59618,null,"See CPT",null,4651.6859999999997,null,4651.6859999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4896)","v":1},4890,59812,null,"See CPT",null,636.32100000000003,null,537.89099999999996,null,"090",0.17,0.6,0.23,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C4920)","v":1},4914,60225,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C4943)","v":1},4937,60699,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C4963)","v":1},4957,61253,null,"See CPT",null,1706.3129999999999,null,1706.3129999999999,null,"090",0.11,0.76,0.13,0,2,2,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C4972)","v":1},4966,61321,null,"See CPT",null,3626.277,null,3626.277,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5006)","v":1},5000,61540,null,"See CPT",null,3714.2850000000003,null,3714.2850000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5015)","v":1},5009,61556,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C5030)","v":1},5024,61583,null,"See CPT",null,5079.567,null,5079.567,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5044)","v":1},5038,61606,null,"See CPT",null,5088.8310000000001,null,5088.8310000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5073)","v":1},5067,61702,null,"See CPT",null,6816.567,null,6816.567,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5091)","v":1},5085,61797,null,"See CPT",null,369.98099999999999,null,369.98099999999999,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5110)","v":1},5104,62117,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C5120)","v":1},5114,62148,null,"See CPT",null,211.33499999999998,null,211.33499999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5141)","v":1},5135,62263,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C5171)","v":1},5165,62329,null,"See CPT",null,592.89599999999996,null,189.91199999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5188)","v":1},5182,63012,null,"See CPT",null,2051.3969999999999,null,2051.3969999999999,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5195)","v":1},5189,63040,null,"See CPT",null,2384.3220000000001,null,2384.3220000000001,null,"090",0.11,0.76,0.13,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5217)","v":1},5211,63086,null,"See CPT",null,320.76600000000002,null,320.76600000000002,null,"000",0,0,0,0,0,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5238)","v":1},5232,63250,null,"See CPT",null,5039.0370000000003,null,5039.0370000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5260)","v":1},5254,63290,null,"See CPT",null,4747.2209999999995,null,4747.2209999999995,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5281)","v":1},5275,63685,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5289)","v":1},5283,63710,null,"See CPT",null,1869.0119999999999,null,1869.0119999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5318)","v":1},5312,64479,null,"See CPT",null,486.36,null,226.38900000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5336)","v":1},5330,64530,null,"See CPT",null,427.88099999999997,null,163.27799999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5342)","v":1},5336,64569,null,"See CPT",null,1317.8040000000001,null,1317.8040000000001,null,"090",0.11,0.76,0.13,0,2,1,0,1,1,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5365)","v":1},5359,64635,null,"See CPT",null,767.75400000000002,null,386.19299999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5386)","v":1},5380,64719,null,"See CPT",null,709.27499999999998,null,709.27499999999998,null,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C5403)","v":1},5397,64771,null,"See CPT",null,1049.7269999999999,null,1049.7269999999999,null,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5415)","v":1},5409,64792,null,"See CPT",null,1841.799,null,1841.799,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5446)","v":1},5440,64886,null,"See CPT",null,2226.2550000000001,null,2226.2550000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5462)","v":1},5456,64913,null,"See CPT",null,301.65899999999999,null,301.65899999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5470)","v":1},5464,65112,null,"See CPT",null,2602.605,null,2602.605,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5487)","v":1},5481,65272,null,"See CPT",null,943.77,null,607.37099999999998,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5513)","v":1},5507,65771,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C5534)","v":1},5528,65920,null,"See CPT",null,1363.5450000000001,null,1363.5450000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5550)","v":1},5544,66185,null,"See CPT",null,1461.9749999999999,null,1461.9749999999999,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5563)","v":1},5557,66710,null,"See CPT",null,771.22799999999995,null,670.48199999999997,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5593)","v":1},5587,67027,null,"See CPT",null,1450.9739999999999,null,1450.9739999999999,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5610)","v":1},5604,67120,null,"See CPT",null,1177.107,null,952.45499999999993,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5631)","v":1},5625,67320,null,"See CPT",null,532.67999999999995,null,532.67999999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5635)","v":1},5629,67335,null,"See CPT",null,245.49600000000001,null,245.49600000000001,null,"000",0,0,0,0,0,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5660)","v":1},5654,67710,null,"See CPT",null,453.35699999999997,null,169.06799999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5678)","v":1},5672,67902,null,"See CPT",null,1243.692,null,1243.692,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5707)","v":1},5701,68100,null,"See CPT",null,326.55599999999998,null,162.69900000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5721)","v":1},5715,68362,null,"See CPT",null,1121.5230000000001,null,1121.5230000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5732)","v":1},5726,68530,null,"See CPT",null,788.01899999999989,null,431.93399999999997,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5745)","v":1},5739,68811,null,"See CPT",null,231.02100000000002,null,231.02100000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5779)","v":1},5773,69450,null,"See CPT",null,1020.198,null,1020.198,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5782)","v":1},5776,69505,null,"See CPT",null,2266.7849999999999,null,2266.7849999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C5808)","v":1},5802,69650,null,"See CPT",null,1476.45,null,1476.45,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5825)","v":1},5819,69720,null,"See CPT",null,2166.6179999999999,null,2166.6179999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5855)","v":1},5849,70110,"TC","See CPT",null,57.9,null,57.9,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5858)","v":1},5852,70120,"TC","See CPT",null,53.847000000000001,null,53.847000000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5886)","v":1},5880,70210,26,"See CPT",null,14.475,null,14.475,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5905)","v":1},5899,70320,null,"See CPT",null,101.325,null,101.325,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5929)","v":1},5923,70370,null,"See CPT",null,176.01599999999999,null,176.01599999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5930)","v":1},5924,70370,"TC","See CPT",null,151.119,null,151.119,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5953)","v":1},5947,70481,null,"See CPT",null,353.19,null,353.19,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5977)","v":1},5971,70496,null,"See CPT",null,532.101,null,532.101,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C5996)","v":1},5990,70545,"TC","See CPT",null,356.08500000000004,null,356.08500000000004,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6006)","v":1},6000,70548,26,"See CPT",null,123.32699999999998,null,123.32699999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6033)","v":1},6027,70559,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C6053)","v":1},6047,71110,"TC","See CPT",null,54.425999999999995,null,54.425999999999995,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6076)","v":1},6070,71275,null,"See CPT",null,543.68100000000004,null,543.68100000000004,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6082)","v":1},6076,71551,null,"See CPT",null,774.12299999999993,null,774.12299999999993,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6103)","v":1},6097,72070,null,"See CPT",null,58.478999999999999,null,58.478999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6118)","v":1},6112,72082,null,"See CPT",null,126.80099999999999,null,126.80099999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6150)","v":1},6144,72128,26,"See CPT",null,82.217999999999989,null,82.217999999999989,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6161)","v":1},6155,72132,"TC","See CPT",null,226.96799999999999,null,226.96799999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6175)","v":1},6169,72147,null,"See CPT",null,550.62900000000002,null,550.62900000000002,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C6204)","v":1},6198,72191,26,"See CPT",null,147.64499999999998,null,147.64499999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6222)","v":1},6216,72197,26,"See CPT",null,180.648,null,180.648,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6228)","v":1},6222,72200,26,"See CPT",null,13.895999999999999,null,13.895999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6251)","v":1},6245,72285,"TC","See CPT",null,128.53800000000001,null,128.53800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C6265)","v":1},6259,73030,null,"See CPT",null,61.374000000000002,null,61.374000000000002,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6298)","v":1},6292,73115,null,"See CPT",null,248.96999999999997,null,248.96999999999997,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6308)","v":1},6302,73140,"TC","See CPT",null,55.583999999999996,null,55.583999999999996,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6327)","v":1},6321,73219,26,"See CPT",null,133.749,null,133.749,null,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C6348)","v":1},6342,73502,26,"See CPT",null,19.106999999999999,null,19.106999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6369)","v":1},6363,73552,26,"See CPT",null,15.054,null,15.054,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6377)","v":1},6371,73564,"TC","See CPT",null,63.690000000000005,null,63.690000000000005,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6393)","v":1},6387,73600,26,"See CPT",null,13.317,null,13.317,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6420)","v":1},6414,73702,26,"See CPT",null,100.167,null,100.167,null,"000",0,0,0,1,9,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6436)","v":1},6430,73722,null,"See CPT",null,648.4799999999999,null,648.4799999999999,null,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C6449)","v":1},6443,74019,"TC","See CPT",null,46.899000000000001,null,46.899000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6479)","v":1},6473,74178,"TC","See CPT",null,508.36199999999997,null,508.36199999999997,null,"000",0,0,0,1,9,0,9,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6496)","v":1},6490,74210,null,"See CPT",null,178.33199999999999,null,178.33199999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6516)","v":1},6510,74246,26,"See CPT",null,73.533000000000001,null,73.533000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6525)","v":1},6519,74251,26,"See CPT",null,96.692999999999998,null,96.692999999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6540)","v":1},6534,74280,26,"See CPT",null,104.22,null,104.22,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6568)","v":1},6562,74360,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C6593)","v":1},6587,74440,"TC","See CPT",null,154.01400000000001,null,154.01400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6601)","v":1},6595,74455,null,"See CPT",null,196.85999999999999,null,196.85999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6622)","v":1},6616,74742,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C6644)","v":1},6638,75571,"TC","See CPT",null,142.434,null,142.434,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C6665)","v":1},6659,75635,26,"See CPT",null,195.12299999999999,null,195.12299999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6668)","v":1},6662,75705,26,"See CPT",null,194.54399999999998,null,194.54399999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6694)","v":1},6688,75746,"TC","See CPT",null,159.80399999999997,null,159.80399999999997,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6711)","v":1},6705,75807,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,2,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C6741)","v":1},6735,75842,null,"See CPT",null,294.13200000000001,null,294.13200000000001,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6748)","v":1},6742,75870,"TC","See CPT",null,205.54499999999999,null,205.54499999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6770)","v":1},6764,75893,26,"See CPT",null,43.424999999999997,null,43.424999999999997,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6791)","v":1},6785,75958,26,"See CPT",null,320.18700000000001,null,320.18700000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6813)","v":1},6807,76098,null,"See CPT",null,74.691000000000003,null,74.691000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C6820)","v":1},6814,76101,"TC","See CPT",null,139.53900000000002,null,139.53900000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C6852)","v":1},6846,76497,26,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C6867)","v":1},6861,76511,26,"See CPT",null,60.795000000000002,null,60.795000000000002,null,"000",0,0,0,1,9,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6876)","v":1},6870,76514,26,"See CPT",null,13.317,null,13.317,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6892)","v":1},6886,76604,26,"See CPT",null,47.477999999999994,null,47.477999999999994,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6919)","v":1},6913,76800,26,"See CPT",null,99.587999999999994,null,99.587999999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6939)","v":1},6933,76813,"TC","See CPT",null,122.748,null,122.748,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6956)","v":1},6950,76819,null,"See CPT",null,156.33000000000001,null,156.33000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C6968)","v":1},6962,76826,null,"See CPT",null,305.13299999999998,null,305.13299999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C6999)","v":1},6993,76881,"TC","See CPT",null,64.269000000000005,null,64.269000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7015)","v":1},7009,76936,26,"See CPT",null,161.541,null,161.541,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7023)","v":1},7017,76941,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C7040)","v":1},7034,76975,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C7065)","v":1},7059,76999,26,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7084)","v":1},7078,77013,26,"See CPT",null,313.23899999999998,null,313.23899999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7094)","v":1},7088,77046,null,"See CPT",null,429.61799999999999,null,429.61799999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C7127)","v":1},7121,77067,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,2,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7137)","v":1},7131,77074,null,"See CPT",null,116.958,null,116.958,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7151)","v":1},7145,77078,26,"See CPT",null,20.843999999999998,null,20.843999999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7184)","v":1},7178,77295,26,"See CPT",null,379.82399999999996,null,379.82399999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7188)","v":1},7182,77300,null,"See CPT",null,116.958,null,116.958,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7213)","v":1},7207,77331,26,"See CPT",null,77.007000000000005,null,77.007000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7231)","v":1},7225,77373,null,"See CPT",null,2102.9279999999999,null,2102.9279999999999,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7242)","v":1},7236,77417,null,"See CPT",null,20.843999999999998,null,20.843999999999998,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7274)","v":1},7268,77620,"TC","See CPT",null,1041.6209999999999,null,1041.6209999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7285)","v":1},7279,77763,null,"See CPT",null,1325.9099999999999,null,1325.9099999999999,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7298)","v":1},7292,77771,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7332)","v":1},7326,78018,26,"See CPT",null,67.742999999999995,null,67.742999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7339)","v":1},7333,78071,null,"See CPT",null,642.68999999999994,null,642.68999999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7359)","v":1},7353,78104,26,"See CPT",null,63.690000000000005,null,63.690000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7382)","v":1},7376,78185,"TC","See CPT",null,286.60500000000002,null,286.60500000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7402)","v":1},7396,78216,null,"See CPT",null,233.916,null,233.916,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7411)","v":1},7405,78230,null,"See CPT",null,319.60799999999995,null,319.60799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7439)","v":1},7433,78268,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7458)","v":1},7452,78305,null,"See CPT",null,508.36199999999997,null,508.36199999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7463)","v":1},7457,78306,26,"See CPT",null,68.900999999999996,null,68.900999999999996,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7487)","v":1},7481,78431,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C7506)","v":1},7500,78452,26,"See CPT",null,133.16999999999999,null,133.16999999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C7530)","v":1},7524,78468,26,"See CPT",null,65.426999999999992,null,65.426999999999992,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7549)","v":1},7543,78492,null,"See CPT",null,3159.9542145600003,null,3159.9542145599999,null,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C7559)","v":1},7553,78499,26,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7580)","v":1},7574,78600,"TC","See CPT",null,298.76400000000001,null,298.76400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7591)","v":1},7585,78608,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7627)","v":1},7621,78708,null,"See CPT",null,317.29200000000003,null,317.29200000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7634)","v":1},7628,78725,"TC","See CPT",null,175.43699999999998,null,175.43699999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C7656)","v":1},7650,78802,26,"See CPT",null,63.690000000000005,null,63.690000000000005,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7671)","v":1},7665,78813,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7685)","v":1},7679,78831,null,"See CPT",null,1300.434,null,1300.434,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7714)","v":1},7708,79440,"TC","See CPT",null,75.27,null,75.27,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C7732)","v":1},7726,80143,null,"See CPT",null,26.468799999999998,null,26.468799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C7757)","v":1},7751,80180,null,"See CPT",null,25.631,null,25.631,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C7775)","v":1},7769,80201,null,"See CPT",null,16.926399999999997,null,16.926399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C7781)","v":1},7775,80235,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7804)","v":1},7798,80337,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7825)","v":1},7819,80358,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7842)","v":1},7836,80375,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7854)","v":1},7848,80417,null,"See CPT",null,62.465800000000002,null,62.465800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C7885)","v":1},7879,81109,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7901)","v":1},7895,81172,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7922)","v":1},7916,81193,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7930)","v":1},7924,81206,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7946)","v":1},7940,81225,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7977)","v":1},7971,81256,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C7989)","v":1},7983,81268,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8002)","v":1},7996,81284,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8032)","v":1},8026,81314,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8049)","v":1},8043,81331,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8070)","v":1},8064,81353,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8074)","v":1},8068,81361,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8099)","v":1},8093,81407,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8117)","v":1},8111,81432,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8128)","v":1},8122,81445,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8154)","v":1},8148,81521,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8175)","v":1},8169,82013,null,"See CPT",null,17.451799999999999,null,17.451799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8197)","v":1},8191,82128,null,"See CPT",null,19.695399999999999,null,19.695399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8218)","v":1},8212,82248,null,"See CPT",null,7.1283999999999992,null,7.1283999999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8221)","v":1},8215,82270,null,"See CPT",null,6.2195999999999998,null,6.2195999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8247)","v":1},8241,82387,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8264)","v":1},8258,82530,null,"See CPT",null,23.728200000000001,null,23.728200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8276)","v":1},8270,82595,null,"See CPT",null,9.1873999999999985,null,9.1873999999999985,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8297)","v":1},8291,82677,null,"See CPT",null,34.335599999999999,null,34.335599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C8325)","v":1},8319,82820,null,"See CPT",null,18.942799999999998,null,18.942799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8344)","v":1},8338,82979,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8349)","v":1},8343,83006,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8373)","v":1},8367,83080,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8386)","v":1},8380,83525,null,"See CPT",null,16.230599999999999,null,16.230599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8420)","v":1},8414,83775,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8429)","v":1},8423,83873,null,"See CPT",null,24.423999999999999,null,24.423999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8445)","v":1},8439,83951,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8472)","v":1},8466,84138,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8492)","v":1},8486,84181,null,"See CPT",null,24.182600000000001,null,24.182600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8496)","v":1},8490,84203,null,"See CPT",null,13.8308,null,13.8308,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8521)","v":1},8515,84376,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8542)","v":1},8536,84460,null,"See CPT",null,7.5259999999999998,null,7.5259999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8557)","v":1},8551,84540,null,"See CPT",null,7.8951999999999991,null,7.8951999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8571)","v":1},8565,84600,null,"See CPT",null,24.296199999999999,null,24.296199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8594)","v":1},8588,85046,null,"See CPT",null,7.9093999999999998,null,7.9093999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8618)","v":1},8612,85293,null,"See CPT",null,26.880599999999998,null,26.880599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8637)","v":1},8631,85380,null,"See CPT",null,14.455599999999999,null,14.455599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8647)","v":1},8641,85420,null,"See CPT",null,9.2726000000000006,null,9.2726000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8680)","v":1},8674,85810,null,"See CPT",null,16.571400000000001,null,16.571400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C8690)","v":1},8684,86038,null,"See CPT",null,17.1678,null,17.1678,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8704)","v":1},8698,86155,null,"See CPT",null,22.7058,null,22.7058,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8719)","v":1},8713,86256,null,"See CPT",null,17.111000000000001,null,17.111000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8747)","v":1},8741,86336,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C8766)","v":1},8760,86403,null,"See CPT",null,16.386799999999997,null,16.386799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8787)","v":1},8781,86611,null,"See CPT",null,14.455599999999999,null,14.455599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8808)","v":1},8802,86658,null,"See CPT",null,18.502599999999997,null,18.502599999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8816)","v":1},8810,86677,null,"See CPT",null,23.927,null,23.927,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8845)","v":1},8839,86738,null,"See CPT",null,18.800799999999999,null,18.800799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8863)","v":1},8857,86784,null,"See CPT",null,17.8352,null,17.8352,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8869)","v":1},8863,86794,null,"See CPT",null,23.927,null,23.927,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8892)","v":1},8886,86849,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C8912)","v":1},8906,86923,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C8935)","v":1},8929,87045,null,"See CPT",null,13.404799999999998,null,13.404799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8955)","v":1},8949,87118,null,"See CPT",null,20.746199999999998,null,20.746199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C8964)","v":1},8958,87164,26,"See CPT",null,33.002999999999993,null,33.002999999999993,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C8979)","v":1},8973,87197,null,"See CPT",null,21.328399999999998,null,21.328399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9011)","v":1},9005,87299,null,"See CPT",null,22.862000000000002,null,22.862000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9014)","v":1},9008,87305,null,"See CPT",null,17.011600000000001,null,17.011600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9040)","v":1},9034,87430,null,"See CPT",null,23.870199999999997,null,23.870199999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9061)","v":1},9055,87498,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9077)","v":1},9071,87525,null,"See CPT",null,42.315999999999995,null,42.315999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9090)","v":1},9084,87538,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9120)","v":1},9114,87637,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9137)","v":1},9131,87804,null,"See CPT",null,23.501000000000001,null,23.501000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9144)","v":1},9138,87850,null,"See CPT",null,34.8752,null,34.8752,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9162)","v":1},9156,88016,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9187)","v":1},9181,88120,26,"See CPT",null,98.429999999999993,null,98.429999999999993,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9209)","v":1},9203,88161,"TC","See CPT",null,83.375999999999991,null,83.375999999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9224)","v":1},9218,88174,null,"See CPT",null,36.025399999999998,null,36.025399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9238)","v":1},9232,88199,26,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C9259)","v":1},9253,88274,null,"See CPT",null,60.179600000000001,null,60.179600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9272)","v":1},9266,88302,26,"See CPT",null,11.58,null,11.58,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9306)","v":1},9300,88331,null,"See CPT",null,181.22699999999998,null,181.22699999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9309)","v":1},9303,88332,null,"See CPT",null,95.534999999999997,null,95.534999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9335)","v":1},9329,88355,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9352)","v":1},9346,88363,null,"See CPT",null,39.950999999999993,null,33.002999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9364)","v":1},9358,88367,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9395)","v":1},9389,88388,26,"See CPT",null,40.529999999999994,null,40.529999999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9407)","v":1},9401,89051,null,"See CPT",null,7.9519999999999991,null,7.9519999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C9419)","v":1},9413,89253,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9454)","v":1},9448,90281,null,"See CPT",null,24.8,null,24.8,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9456)","v":1},9450,90284,null,"See CPT",null,8.2100000000000009,null,8.2100000000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9483)","v":1},9477,90586,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9504)","v":1},9498,90661,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9523)","v":1},9517,90690,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9533)","v":1},9527,90714,null,"See CPT",null,25.1,null,25.1,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C9560)","v":1},9554,90838,null,"See CPT",null,201.49199999999999,null,179.49,null,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9580)","v":1},9574,90889,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C9603)","v":1},9597,90964,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9605)","v":1},9599,90966,null,"See CPT",null,507.78299999999996,null,507.78299999999996,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9627)","v":1},9621,91030,"TC","See CPT",null,187.017,null,187.017,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9652)","v":1},9646,91111,26,"See CPT",null,87.429000000000002,null,87.429000000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9670)","v":1},9664,91299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C9681)","v":1},9675,92014,null,"See CPT",null,221.178,null,130.85399999999998,null,"000",0,0,0,0,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9707)","v":1},9701,92132,null,"See CPT",null,55.583999999999996,null,55.583999999999996,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9728)","v":1},9722,92229,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,9,2,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9749)","v":1},9743,92273,null,"See CPT",null,234.49499999999998,null,234.49499999999998,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9755)","v":1},9749,92284,"TC","See CPT",null,85.113,null,85.113,null,"000",0,0,0,1,9,2,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9778)","v":1},9772,92353,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C9792)","v":1},9786,92512,null,"See CPT",null,110.00999999999999,null,47.477999999999994,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9807)","v":1},9801,92537,null,"See CPT",null,73.533000000000001,null,73.533000000000001,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9835)","v":1},9829,92549,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9850)","v":1},9844,92563,null,"See CPT",null,57.9,null,57.9,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9878)","v":1},9872,92597,null,"See CPT",null,124.48499999999999,null,124.48499999999999,null,"000",0,0,0,9,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C9897)","v":1},9891,92620,null,"See CPT",null,162.11999999999998,null,139.53900000000002,null,"000",0,0,0,9,0,2,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9902)","v":1},9896,92630,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C9926)","v":1},9920,92961,null,"See CPT",null,420.35399999999998,null,420.35399999999998,null,"000",0,0,0,0,9,9,9,9,9,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9939)","v":1},9933,92986,null,"See CPT",null,2260.4159999999997,null,2260.4159999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9955)","v":1},9949,93025,"TC","See CPT",null,182.964,null,182.964,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C9976)","v":1},9970,93260,26,"See CPT",null,72.953999999999994,null,72.953999999999994,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10006)","v":1},10000,93284,"TC","See CPT",null,81.059999999999988,null,81.059999999999988,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10023)","v":1},10017,93290,"TC","See CPT",null,57.9,null,57.9,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10043)","v":1},10037,93304,"TC","See CPT",null,238.548,null,238.548,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10052)","v":1},10046,93308,"TC","See CPT",null,141.85500000000002,null,141.85500000000002,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10067)","v":1},10061,93317,26,"See CPT",null,154.59299999999999,null,154.59299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10095)","v":1},10089,93453,null,"See CPT",null,2248.2570000000001,null,2248.2570000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10110)","v":1},10104,93458,null,"See CPT",null,2039.8169999999998,null,2039.8169999999998,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10124)","v":1},10118,93464,null,"See CPT",null,434.25,null,434.25,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10153)","v":1},10147,93567,null,"See CPT",null,215.96699999999998,null,88.587000000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10171)","v":1},10165,93602,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10190)","v":1},10184,93616,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10200)","v":1},10194,93620,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10214)","v":1},10208,93631,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10243)","v":1},10237,93702,null,"See CPT",null,270.39299999999997,null,270.39299999999997,null,"000",0,0,0,3,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10250)","v":1},10244,93745,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10275)","v":1},10269,93888,26,"See CPT",null,43.424999999999997,null,43.424999999999997,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10297)","v":1},10291,93925,null,"See CPT",null,466.09500000000003,null,466.09500000000003,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10318)","v":1},10312,93976,null,"See CPT",null,297.02699999999999,null,297.02699999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10340)","v":1},10334,93990,"TC","See CPT",null,239.12699999999998,null,239.12699999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10342)","v":1},10336,93998,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,0,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C10369)","v":1},10363,94375,"TC","See CPT",null,45.741,null,45.741,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10385)","v":1},10379,94621,"TC","See CPT",null,165.59399999999999,null,165.59399999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10398)","v":1},10392,94680,"TC","See CPT",null,76.427999999999997,null,76.427999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10422)","v":1},10416,94772,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C10445)","v":1},10439,95070,null,"See CPT",null,64.847999999999999,null,64.847999999999999,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10465)","v":1},10459,95180,null,"See CPT",null,243.18,null,178.911,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10488)","v":1},10482,95722,null,"See CPT",null,440.61900000000003,null,431.35500000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10495)","v":1},10489,95782,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C10526)","v":1},10520,95812,null,"See CPT",null,643.84799999999996,null,643.84799999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10542)","v":1},10536,95824,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C10550)","v":1},10544,95852,null,"See CPT",null,32.423999999999999,null,9.2639999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10567)","v":1},10561,95866,null,"See CPT",null,245.49600000000001,null,245.49600000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10593)","v":1},10587,95875,26,"See CPT",null,100.746,null,100.746,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10614)","v":1},10608,95909,"TC","See CPT",null,119.85299999999999,null,119.85299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10636)","v":1},10630,95924,null,"See CPT",null,270.97199999999998,null,270.97199999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10643)","v":1},10637,95926,"TC","See CPT",null,220.01999999999998,null,220.01999999999998,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10673)","v":1},10667,95943,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C10690)","v":1},10684,95962,26,"See CPT",null,297.60599999999999,null,297.60599999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10697)","v":1},10691,95966,26,"See CPT",null,366.50700000000001,null,366.50700000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10715)","v":1},10709,95999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C10740)","v":1},10734,96139,null,"See CPT",null,67.163999999999987,null,67.163999999999987,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10758)","v":1},10752,96368,null,"See CPT",null,38.792999999999999,null,38.792999999999999,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10769)","v":1},10763,96401,null,"See CPT",null,152.27699999999999,null,152.27699999999999,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10801)","v":1},10795,96913,null,"See CPT",null,276.18299999999999,null,276.18299999999999,null,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10812)","v":1},10806,97010,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C10825)","v":1},10819,97036,null,"See CPT",null,60.795000000000002,null,60.795000000000002,null,"000",0,0,0,9,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10841)","v":1},10835,97155,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C10862)","v":1},10856,97545,null,"See CPT",null,157.70733263999998,null,157.70733263999998,null,"000",0,0,0,9,0,0,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C10888)","v":1},10882,98928,null,"See CPT",null,125.06400000000001,null,100.746,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10905)","v":1},10899,99002,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C10917)","v":1},10911,99072,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C10948)","v":1},10942,99203,null,"See CPT",null,194.54399999999998,null,141.85500000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10960)","v":1},10954,99221,null,"See CPT",null,169.64699999999999,null,169.64699999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10985)","v":1},10979,99282,null,"See CPT",null,71.795999999999992,null,71.795999999999992,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C10990)","v":1},10984,99291,null,"See CPT",null,483.46499999999997,null,370.56,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C11014)","v":1},11008,99342,null,"See CPT",null,130.85399999999998,null,130.85399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C11033)","v":1},11027,99375,null,"See CPT",null,177.17400000000001,null,148.22399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C11057)","v":1},11051,99407,null,"See CPT",null,49.793999999999997,null,43.424999999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C11076)","v":1},11070,99449,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11086)","v":1},11080,99460,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11113)","v":1},11107,99491,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11133)","v":1},11127,99512,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11137)","v":1},11131,99605,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11162)","v":1},11156,"0016M",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11180)","v":1},11174,"0072T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11205)","v":1},11199,"0098U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11212)","v":1},11206,"0102U",null,"See CPT",null,1630.2294921600001,null,1630.2294921600001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$B$2,C11241)","v":1},11235,"0127U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11255)","v":1},11249,"0141U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11265)","v":1},11259,"0151U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11284)","v":1},11278,"0184T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11308)","v":1},11302,"0213U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11331)","v":1},11325,"0227U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11345)","v":1},11339,"0237T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C11360)","v":1},11354,"0270T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11388)","v":1},11382,"0345T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11407)","v":1},11401,"0380R",null,"Job modification",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C11431)","v":1},11425,"0409A",null,"Claimant - dinner",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
[{"$f":"SEARCH(Lookup!$B$2,C11432)","v":1},11426,"0409T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11457)","v":1},11451,"0427T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11473)","v":1},11467,"0442T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11500)","v":1},11494,"0474T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11516)","v":1},11510,"0491T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11529)","v":1},11523,"0502F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11559)","v":1},11553,"0523T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C11576)","v":1},11570,"0535T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11596)","v":1},11590,"0551T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11605)","v":1},11599,"0557T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11620)","v":1},11614,"0570T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11652)","v":1},11646,"0622T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11663)","v":1},11657,"0633T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11677)","v":1},11671,"0811V",null,"Assessment services - intern",null,8.4330417600000001,null,8.4330417600000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C11702)","v":1},11696,"1002F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11724)","v":1},11718,"1034F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11727)","v":1},11721,"1038F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11748)","v":1},11742,"1067M",null,"Assess impeds to rtrn to work, mentor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C11774)","v":1},11768,"1111F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11791)","v":1},11785,"1126M",null,"Additional Complex IME Provider",null,768.92,null,768.92,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C11803)","v":1},11797,"1135M",null,"Ime, late cancellation fee, psychiatrist",null,371.28487968000002,null,371.28487968000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C11828)","v":1},11822,"1170F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11850)","v":1},11844,"1225M",null,"Nurse case management travel expenses (parking, tolls, ferry, lodging, airfare)",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C11871)","v":1},11865,"1302W",null,"Stay at work tools & equipment",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C11875)","v":1},11869,"1306W",null,"Stay at work materials",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C11895)","v":1},11889,"1726M",null,"PGAP Coordination 11-20 Minutes",null,52.3566,null,49.633199999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C11922)","v":1},11916,"2029F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11947)","v":1},11941,"3019F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11956)","v":1},11950,"3037F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11972)","v":1},11966,"3066F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C11999)","v":1},11993,"3118F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12019)","v":1},12013,"3250F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12023)","v":1},12017,"3267F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12048)","v":1},12042,"3318F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12060)","v":1},12054,"3341F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12095)","v":1},12089,"3493F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12103)","v":1},12097,"3503F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12120)","v":1},12114,"3725F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12146)","v":1},12140,"4013F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12167)","v":1},12161,"4049F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12174)","v":1},12168,"4056F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12188)","v":1},12182,"4079F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12217)","v":1},12211,"4159F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12231)","v":1},12225,"4179F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12246)","v":1},12240,"4196F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12268)","v":1},12262,"4271F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12293)","v":1},12287,"4541F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12311)","v":1},12305,"5015F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12322)","v":1},12316,"5200F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$B$2,C12354)","v":1},12348,"8901H",null,"Attendant svcs by department approved sp",null,14.566163040000001,null,14.566163040000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12365)","v":1},12359,"8971H",null,"Home health aid svscs per 15 mins",null,7.9289496000000002,null,7.9289496000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12378)","v":1},12372,"9974M",null,"INTERPRETER SYSTEM PER MINUTE",null,1.0302,null,1.0302,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12394)","v":1},12388,"A0140",null,"Nonemergency transport air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C12419)","v":1},12413,"A0431",null,"Rotary wing air transport",null,7495.3778874099853,null,7495.3778874099853,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12439)","v":1},12433,"A4218",null,"Sterile saline or water",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12462)","v":1},12456,"A4255",null,"Glucose monitor platforms",null,4.8857999999999997,null,4.8857999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12482)","v":1},12476,"A4285",null,"Replcmnt breast pump bottle",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C12491)","v":1},12485,"A4312",null,"Cath w/o bag 2-way silicone",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12519)","v":1},12513,"A4355",null,"Bladder irrigation tubing",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12538)","v":1},12532,"A4378",null,"Drainable rubber pch w/o fp",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12543)","v":1},12537,"A4383",null,"Urinary rubber pouch w/o fp",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12567)","v":1},12561,"A4410",null,"Ost skn barr extnd >4 sq",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12586)","v":1},12580,"A4429",null,"Urine ost pouch w bltinconv",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12610)","v":1},12604,"A4510",null,"Full length surg stocking",null,124.13,null,124.13,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12629)","v":1},12623,"A4595",null,"Tens suppl 2 lead per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C12639)","v":1},12633,"A4613",null,"Battery charger",null,191.75556912000002,null,191.75556912000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12664)","v":1},12658,"A4642",null,"In111 satumomab",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C12671)","v":1},12665,"A4657",null,"Syringe w/wo needle",null,0.82,null,0.82,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12689)","v":1},12683,"A4722",null,"Dialys sol fld vol > 1999cc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C12714)","v":1},12708,"A4913",null,"Misc dialysis supplies noc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C12736)","v":1},12730,"A5082",null,"Continent stoma catheter",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12751)","v":1},12745,"A5501",null,"Diabetic custom molded shoe",null,226.4502,null,226.4502,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C12765)","v":1},12759,"A6021",null,"Collagen dressing <=16 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12794)","v":1},12788,"A6222",null,"Gauze <=16 in no w/sal w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12812)","v":1},12806,"A6243",null,"Hydrogel drg >16<=48 w/o bdr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12818)","v":1},12812,"A6250",null,"Skin seal protect moisturizr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12837)","v":1},12831,"A6411",null,"Non-sterile eye pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C12861)","v":1},12855,"A6503",null,"Compres burngarment facehood",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C12884)","v":1},12878,"A6544",null,"Gc stocking garter belt",null,107.25,null,107.25,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12905)","v":1},12899,"A7018",null,"Water distilled w/nebulizer",null,0.40800000000000003,null,0.40800000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12922)","v":1},12916,"A7040",null,"One way chest drain valve",null,46.869000000000007,null,46.869000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12934)","v":1},12928,"A7506",null,"Hmes/trachvalve adhesivedisk",null,0.3876,null,0.3876,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12946)","v":1},12940,"A8000",null,"Soft protect helmet prefab",null,281.99348400000002,null,281.99348400000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12981)","v":1},12975,"A9509",null,"Iodine i-123 sod iodide mil",null,1027.05,null,1027.05,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C12983)","v":1},12977,"A9512",null,"Tc99m pertechnetate",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C13010)","v":1},13004,"A9551",null,"Tc99m succimer",null,683.34,null,683.34,null,"000",0,0,0,0,0,0,0,0,0,null,"D",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C13026)","v":1},13020,"A9568",null,"Technetium tc99m arcitumomab",null,1235,null,1235,null,"000",0,0,0,0,0,0,0,0,0,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C13039)","v":1},13033,"A9583",null,"Gadofosveset trisodium inj",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C13069)","v":1},13063,"B4087",null,"Gastro/jejuno tube, std",null,34.884,null,34.884,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C13082)","v":1},13076,"B4157",null,"Ef special metabolic inherit",null,6.71,null,6.71,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C13093)","v":1},13087,"B4180",null,"Parenteral sol carb > 50%",null,30.079799999999999,null,30.079799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C13129)","v":1},13123,"C1728",null,"Cath, brachytx seed adm",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13132)","v":1},13126,"C1731",null,"Cath, ep, 20 or more elec",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13154)","v":1},13148,"C1766",null,"Intro/sheath,strble,non-peel",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13179)","v":1},13173,"C1816",null,"Receiver/transmitter, neuro",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13197)","v":1},13191,"C1877",null,"Stent, non-coat/cov w/o del",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13208)","v":1},13202,"C1889",null,"Implant/insert device, noc",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C13234)","v":1},13228,"C2626",null,"Infusion pump, non-prog,temp",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13255)","v":1},13249,"C5272",null,"Low cost skin substitute app",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13277)","v":1},13271,"C8920",null,"Mra w/o fol w/cont, pelvis",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13284)","v":1},13278,"C8927",null,"Tee w or w/o fol w/cont, mon",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13301)","v":1},13295,"C9054",null,"Injection, lefamulin",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C13327)","v":1},13321,"C9353",null,"Neurawrap nerve protector,cm",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$B$2,C13344)","v":1},13338,"C9484",null,"Injection, eteplirsen",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13356)","v":1},13350,"C9607",null,"Perc d-e cor revasc chro sin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13381)","v":1},13375,"C9765",null,"Revasc intra lithotrip-stent",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$B$2,C13403)","v":1},13397,"D0171",null,"Re-eval post-op visit",null,66.004567200000011,null,66.004567200000011,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13424)","v":1},13418,"D0350",null,"Oral/facial photo images",null,74.028034079999998,null,74.028034079999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13429)","v":1},13423,"D0367",null,"Cone beam ct interp both jaw",null,377.29197792000002,null,377.29197792000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13453)","v":1},13447,"D0422",null,"Collect & prep genetic samp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13466)","v":1},13460,"D0479",null,"Tissue in-situ hybridization",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13482)","v":1},13476,"D0702",null,"2d cephal radio image",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C13509)","v":1},13503,"D1527",null,"Remove bilat space main, man",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13525)","v":1},13519,"D2335",null,"Resin 4/> surf or w incis an",null,326.45218320000004,null,326.45218320000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13552)","v":1},13546,"D2710",null,"Crown resin-based indirect",null,1001.6416238400001,null,1001.6416238400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13572)","v":1},13566,"D2915",null,"Recement cast or prefab post",null,123.08250240000001,null,123.08250240000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13576)","v":1},13570,"D2929",null,"Prefab porc/ceram crown pri",null,373.72132512000002,null,373.72132512000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13601)","v":1},13595,"D2990",null,"Resin infiltration of lesion",null,188.19440640000002,null,188.19440640000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13613)","v":1},13607,"D3331",null,"Non-surg tx root canal obs",null,669.84396336000009,null,669.84396336000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13630)","v":1},13624,"D3429",null,"Bone graft peri each addl",null,569.94970032000003,null,569.94970032000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13651)","v":1},13645,"D4231",null,"Ana crown exp 1-3 per quad",null,618.11150544000009,null,618.11150544000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13680)","v":1},13674,"D4910",null,"Periodontal maint procedures",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13698)","v":1},13692,"D5282",null,"Remove unil part denture,max",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13717)","v":1},13711,"D5670",null,"Replc tth&acrlc on mtl frmwk",null,773.30887920000009,null,773.30887920000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13727)","v":1},13721,"D5750",null,"Denture reln cmplt max lab",null,482.54222016000006,null,482.54222016000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13741)","v":1},13735,"D5866",null,"Overdenture partial mandib",null,2317.2486480000002,null,2317.2486480000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13770)","v":1},13764,"D5953",null,"Adult speech aid",null,2269.6644484800004,null,2269.6644484800004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13784)","v":1},13778,"D5992",null,"Adjust max prost appliance",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13799)","v":1},13793,"D6058",null,"Abutment supported crown",null,1446.72349536,null,1446.72349536,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13827)","v":1},13821,"D6090",null,"Repair implant",null,763.50008592000006,null,763.50008592000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13846)","v":1},13840,"D6114",null,"Implnt/abut fixed dent max",null,8766.8347852800016,null,8766.8347852800016,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13864)","v":1},13858,"D6211",null,"Bridge base metal cast",null,1096.1904096000001,null,1096.1904096000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13875)","v":1},13869,"D6253",null,"Provisional pontic",null,791.15164128000015,null,791.15164128000015,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13896)","v":1},13890,"D6634",null,"Onlay titanium",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C13906)","v":1},13900,"D6780",null,"Crown 3/4 high noble metal",null,1134.54342144,null,1134.54342144,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13925)","v":1},13919,"D7210",null,"Rem imp tooth w mucoper flp",null,291.65932224000005,null,291.65932224000005,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C13949)","v":1},13943,"D7296",null,"Corticotomy, 1-3 teeth",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13972)","v":1},13966,"D7473",null,"Remove torus mandibularis",null,852.69289248000018,null,852.69289248000018,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C13992)","v":1},13986,"D7710",null,"Maxilla open reduct compound",null,4546.1971526400002,null,4546.1971526400002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14015)","v":1},14009,"D7873",null,"Tmj arthroscopy lysis adhesn",null,2156.2017048000002,null,2156.2017048000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14016)","v":1},14010,"D7874",null,"Tmj arthroscopy disc reposit",null,2723.5994385600002,null,2723.5994385600002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14044)","v":1},14038,"D7962",null,"Lingual frenectomy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C14059)","v":1},14053,"D7996",null,"Implant mandible for augment",null,4523.3554766400002,null,4523.3554766400002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14073)","v":1},14067,"D8220",null,"Fixed appliance therapy habt",null,1029.2931792000002,null,1029.2931792000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14096)","v":1},14090,"D9219",null,"Eval mod/deep sed/gen anest",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C14120)","v":1},14114,"D9934",null,"Clean rem part denture max",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C14141)","v":1},14135,"D9990",null,"Trans or sign language svcs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C14157)","v":1},14151,"E0116","NU","Crutch underarm each no wood",null,28.2744,null,28.2744,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14170)","v":1},14164,"E0144","NU","Enclosed walker w rear seat",null,1070.7969999999998,null,1070.7969999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14200)","v":1},14194,"E0171","NU","Commode chair non-electric",null,301.02703488000003,null,301.02703488000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14217)","v":1},14211,"E0189","NU","Lambswool sheepskin pad",null,52.448399999999999,null,52.448399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14224)","v":1},14218,"E0197","NU","Air pressure pad for mattres",null,411.84499999999997,null,411.84499999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14242)","v":1},14236,"E0232","RR","Warming card for nwt",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14267)","v":1},14261,"E0261","RR","Hosp bed semi-electr w/o mat",null,176.505,null,176.505,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14289)","v":1},14283,"E0292","RR","Hosp bed var ht no sr w/matt",null,91.782599999999988,null,91.782599999999988,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C14310)","v":1},14304,"E0305","RR","Rails bed side half length",null,25.887399999999996,null,25.887399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C14318)","v":1},14312,"E0326","NU","Urinal female jug-type",null,11.6586,null,11.6586,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14347)","v":1},14341,"E0447",null,"Port o2 cont, liq over 4 lpm",null,100.3884,null,100.3884,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14365)","v":1},14359,"E0472","RR","Rad w backup invasive intrfc",null,823.68999999999994,null,823.68999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14368)","v":1},14362,"E0481","NU","Intrpulmnry percuss vent sys",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C14389)","v":1},14383,"E0572","RR","Aerosol compressor adjust pr",null,43.067220000000006,null,43.067220000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14415)","v":1},14409,"E0619",null,"Apnea monitor w recorder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C14432)","v":1},14426,"E0637","NU","Combination sit to stand sys",null,4892.7185999999992,null,4892.7185999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14444)","v":1},14438,"E0650","RR","Pneuma compresor non-segment",null,85.512720000000002,null,85.512720000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14475)","v":1},14469,"E0675","NU","Pneumatic compression device",null,4361.7357999999995,null,4361.7357999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14487)","v":1},14481,"E0730",null,"Tens four lead",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C14499)","v":1},14493,"E0755",null,"Electronic salivary reflex s",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C14516)","v":1},14510,"E0780","NU","Mech amb infusion pump <8hrs",null,12.311400000000001,null,12.311400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14536)","v":1},14530,"E0850","NU","Traction stand free standing",null,124.7256,null,124.7256,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14563)","v":1},14557,"E0940","NU","Trapeze bar free standing",null,441.26659999999998,null,441.26659999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C14579)","v":1},14573,"E0954","RR","Foot box, any type each foot",null,5.94,null,5.94,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14592)","v":1},14586,"E0961","NU","Wheelchair brake extension",null,26.2242,null,26.2242,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14613)","v":1},14607,"E0980","RR","Wheelchair safety vest",null,3.92496,null,3.92496,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14640)","v":1},14634,"E1004","RR","Pwr seat recline mech",null,611.8839999999999,null,611.8839999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14660)","v":1},14654,"E1020","NU","Residual limb support system",null,347.13059999999996,null,347.13059999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14664)","v":1},14658,"E1029","NU","W/c vent tray fixed",null,590.70339999999999,null,590.70339999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14689)","v":1},14683,"E1086","NU","Hemi-wheelchair detachable a",null,2288.6855999999998,null,2288.6855999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14707)","v":1},14701,"E1130","NU","Whlchr stand fxd arm ft rest",null,823.68999999999994,null,823.68999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C14732)","v":1},14726,"E1221","NU","Wheelchair spec size w foot",null,588.34999999999991,null,588.34999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C14750)","v":1},14744,"E1231",null,"Rigid ped w/c tilt-in-space",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C14761)","v":1},14755,"E1250","NU","Wheelchair lightwt fixed arm",null,1090.8049999999998,null,1090.8049999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C14787)","v":1},14781,"E1356","RR","Batt pack/cart, port conc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C14808)","v":1},14802,"E1580","RR","Unipuncture control system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C14811)","v":1},14805,"E1594","RR","Cycler dialysis machine",null,933.49620000000004,null,933.49620000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14837)","v":1},14831,"E1815","RR","Adjust ankle ext/flex device",null,150.02160000000001,null,150.02160000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14858)","v":1},14852,"E2204","NU","Frame depth 22 to 25 in",null,882.91200000000003,null,882.91200000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14872)","v":1},14866,"E2212","NU","Pneumatic prop tire tube",null,6.8748000000000005,null,6.8748000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14887)","v":1},14881,"E2227","RR","Gear reduction drive wheel",null,388.31099999999998,null,388.31099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14915)","v":1},14909,"E2323","NU","Special joystick handle",null,69.961800000000011,null,69.961800000000011,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14934)","v":1},14928,"E2340","RR","W/c wdth 20-23 in seat frame",null,42.549300000000002,null,42.549300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14939)","v":1},14933,"E2343","NU","W/c dpth 22-25 in seat frame",null,851.08799999999997,null,851.08799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14959)","v":1},14953,"E2367","NU","Battery charger, dual mode",null,419.60759999999999,null,419.60759999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C14982)","v":1},14976,"E2382","NU","Tube, pneum wheel drive tire",null,19.900200000000002,null,19.900200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C15006)","v":1},15000,"E2395","NU","Caster wheel excludes tire",null,51.652799999999999,null,51.652799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C15019)","v":1},15013,"E2504","NU","Sgd prerec msg>20min <=40min",null,1872.9444000000001,null,1872.9444000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C15035)","v":1},15029,"E2603","NU","Skin protect wc cus wd <22in",null,133.6506,null,133.6506,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C15062)","v":1},15056,"E2631","NU","Elevat proximal arm support",null,287.91539999999998,null,287.91539999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C15082)","v":1},15076,"G0082",null,"Care man h v ext pt 30 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15103)","v":1},15097,"G0118",null,"Glaucoma scrn hgh risk direc",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,0,0,0,0,0,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C15123)","v":1},15117,"G0145",null,"Scr c/v cyto,thinlayer,rescr",null,37.615799999999993,null,37.615799999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C15132)","v":1},15126,"G0159",null,"Hhc pt maint ea 15 min",null,44.129067840000012,null,44.129067840000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C15147)","v":1},15141,"G0202",26,"Scr mammo bi incl cad",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15175)","v":1},15169,"G0255","TC","Current percep threshold tst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15190)","v":1},15184,"G0282",null,"Elect stim wound care not pd",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C15204)","v":1},15198,"G0307",null,"Cbc without platelet",null,9.1873999999999985,null,9.1873999999999985,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C15233)","v":1},15227,"G0405",null,"Ekg interpret & report preve",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,2,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15251)","v":1},15245,"G0424",null,"Pulmonary rehab w exer",null,53.268000000000001,null,23.16,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C15270)","v":1},15264,"G0448",null,"Place perm pacing cardiovert",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15280)","v":1},15274,"G0464",null,"Colorec ca scr, sto bas dna",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15294)","v":1},15288,"G0483",null,"Drug test def 22+ classes",null,350.62639999999999,null,350.62639999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$B$2,C15309)","v":1},15303,"G0508",null,"Crit care telehea consult 60",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,9,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15330)","v":1},15324,"G1009",null,"Cdsm sage health",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15355)","v":1},15349,"G2011",null,"Alcohol/sub abuse assess",null,29.529,null,29.529,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$B$2,C15377)","v":1},15371,"G2076",null,"Intake act w/med exam",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15398)","v":1},15392,"G2100",null,"Pt 66+ frailty and med dem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15402)","v":1},15396,"G2107",null,"Pt 66+ frailty and adv ill",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15422)","v":1},15416,"G2140",null,"Leg pain vas 6-20wk = 3",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15449)","v":1},15443,"G2181",null,"Bmi not doc medrsn ptref",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15465)","v":1},15459,"G2197",null,"Screen hlthy etoh use",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15478)","v":1},15472,"G2210",null,"No neck fs prom no rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15502)","v":1},15496,"G6011",null,"Radiation treatment delivery",null,478.83299999999997,null,478.83299999999997,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C15525)","v":1},15519,"G8421",null,"Bmi not calculated",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15545)","v":1},15539,"G8484",null,"Flu immunize no admin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15550)","v":1},15544,"G8536",null,"No doc elder mal scrn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15575)","v":1},15569,"G8601",null,"No elig tpa init w/in 3 hrs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15587)","v":1},15581,"G8658",null,"Rafscrs llfai no scor + surv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15604)","v":1},15598,"G8711",null,"Pres antibiotic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15630)","v":1},15624,"G8825",null,"Pt not disch to home day#7",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15647)","v":1},15641,"G8854",null,"Reas no adhere pos air pres",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15673)","v":1},15667,"G8912",null,"Pt doc with wrong event",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15694)","v":1},15688,"G8952",null,"Pre-htn/htn, no f/u, not gvn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15697)","v":1},15691,"G8958",null,"Assess vol mgmt not doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15723)","v":1},15717,"G9050",null,"Oncology work-up evaluation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15734)","v":1},15728,"G9061",null,"Onc prac cond noadd by guide",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15752)","v":1},15746,"G9080",null,"Onc dx prostate w/rise psa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15777)","v":1},15771,"G9107",null,"Onc dx pancreatic unresectab",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15795)","v":1},15789,"G9131",null,"Onc dx brst unknown nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15820)","v":1},15814,"G9223",null,"Pjp proph ordered cd4 low",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15838)","v":1},15832,"G9269",null,"Doc no comp or mort w in 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15849)","v":1},15843,"G9282",null,"Doc medrsn no histo type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15862)","v":1},15856,"G9295",null,"Non cutaneous loc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15892)","v":1},15886,"G9351",null,"Doc >1 sinus ct w 90d dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15905)","v":1},15899,"G9368",null,">= 2 same hi-rsk med not ord",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15921)","v":1},15915,"G9404",null,"No 30 day f/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15948)","v":1},15942,"G9431",null,"Patho rpt no pt ctg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15968)","v":1},15962,"G9474",null,"Diet counsel at hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15985)","v":1},15979,"G9509",null,"Adit mdd dys rem 12 mnths",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C15997)","v":1},15991,"G9521",null,"Er and ip hosp <2 in 12 mos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16028)","v":1},16022,"G9582",null,"Door to punc time >2hr, nrg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16040)","v":1},16034,"G9604",null,"Pt surv results not avail",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16047)","v":1},16041,"G9611",null,"No doc order anti-plat rng",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16070)","v":1},16064,"G9638",null,"No doc >1 dose reduc tech",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16094)","v":1},16088,"G9666",null,"Fas/dir ldl 70-189mg/dl mst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16113)","v":1},16107,"G9702",null,"Pt use hosp during msmt per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16137)","v":1},16131,"G9726",null,"Refused to participate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16156)","v":1},16150,"G9753",null,"Doc no dicom, ct other fac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16166)","v":1},16160,"G9764",null,"Pt treatd w/oral syst or bio",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16193)","v":1},16187,"G9791",null,"Most rct tob stat free",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16195)","v":1},16189,"G9793",null,"Pt on daily asa/antiplat",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16217)","v":1},16211,"G9831",null,"Ajcc stg brt ca dx ii or iii",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16242)","v":1},16236,"G9878",null,"2 em core ms mo 7-9 wl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16260)","v":1},16254,"G9901",null,"Pt 66+ snp or ltc pos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16285)","v":1},16279,"G9927",null,"Doc no warf /fda  pt trial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16292)","v":1},16286,"G9939",null,"Same path/derm perf biopsy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16321)","v":1},16315,"H0002",null,"Alcohol and/or drug screenin",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C16339)","v":1},16333,"H0020",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C16345)","v":1},16339,"H0026",null,"Alcohol and/or drug preventi",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16364)","v":1},16358,"H0045",null,"Respite not-in-home per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16388)","v":1},16382,"H2018",null,"Psysoc rehab svc, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16411)","v":1},16405,"J0129",null,"Abatacept injection",null,57.831000000000003,null,57.831000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C16425)","v":1},16419,"J0202",null,"Injection, alemtuzumab",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16440)","v":1},16434,"J0280",null,"Aminophyllin 250 mg inj",null,9.5009999999999994,null,9.5009999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16468)","v":1},16462,"J0490",null,"Belimumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16487)","v":1},16481,"J0587",null,"Inj, rimabotulinumtoxinb",null,11.971,null,11.971,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C16492)","v":1},16486,"J0594",null,"Busulfan injection",null,2.1970000000000001,null,2.1970000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C16512)","v":1},16506,"J0691",null,"Inj lefamulin 1 mg",null,0.72399999999999998,null,0.72399999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16535)","v":1},16529,"J0744",null,"Ciprofloxacin iv",null,0.98899999999999999,null,0.98899999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16559)","v":1},16553,"J0896",null,"Inj luspatercept-aamt 0.25mg",null,36.292999999999999,null,36.292999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$B$2,C16580)","v":1},16574,"J1190",null,"Dexrazoxane hcl injection",null,207.49199999999999,null,207.49199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16596)","v":1},16590,"J1303",null,"Inj., ravulizumab-cwvz 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16609)","v":1},16603,"J1429",null,"Inj golodirsen 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16620)","v":1},16614,"J1450",null,"Fluconazole",null,3.1669999999999998,null,3.1669999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16638)","v":1},16632,"J1562",null,"Vivaglobin, inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16657)","v":1},16651,"J1630",null,"Haloperidol injection",null,1.4319999999999999,null,1.4319999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16685)","v":1},16679,"J1786",null,"Imuglucerase injection",null,43.435000000000002,null,43.435000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16700)","v":1},16694,"J1930",null,"Lanreotide injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16714)","v":1},16708,"J2001",null,"Lidocaine injection",null,2.5999999999999999E-2,null,2.5999999999999999E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16743)","v":1},16737,"J2353",null,"Octreotide injection, depot",null,205.04300000000001,null,205.04300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C16757)","v":1},16751,"J2440",null,"Papaverin hcl injection",null,10.49,null,10.49,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16767)","v":1},16761,"J2513",null,"Pentastarch 10% solution",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16786)","v":1},16780,"J2720",null,"Inj protamine sulfate/10 mg",null,1.2030000000000001,null,1.2030000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16807)","v":1},16801,"J2798",null,"Inj., perseris, 0.5 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16828)","v":1},16822,"J3031",null,"Inj., fremanezumab-vfrm 1 mg",null,1.35,null,1.35,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16854)","v":1},16848,"J3302",null,"Triamcinolone diacetate inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16871)","v":1},16865,"J3385",null,"Velaglucerase alfa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16883)","v":1},16877,"J3470",null,"Hyaluronidase injection",null,60.26,null,60.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16908)","v":1},16902,"J7121",null,"5% dextrose in lac ringers",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C16930)","v":1},16924,"J7194",null,"Factor ix complex",null,1.4850000000000001,null,1.4850000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C16951)","v":1},16945,"J7300",null,"Intraut copper contraceptive",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16959)","v":1},16953,"J7310",null,"Ganciclovir long act implant",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C16975)","v":1},16969,"J7328",null,"Gelsyn-3 injection 0.1 mg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C17002)","v":1},16996,"J7517",null,"Mycophenolate mofetil oral",null,0.374,null,0.374,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17018)","v":1},17012,"J7614",null,"Levalbuterol non-comp unit",null,5.8999999999999997E-2,null,5.8999999999999997E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C17031)","v":1},17025,"J7635",null,"Atropine comp con",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17052)","v":1},17046,"J7668",null,"Metaproterenol non-comp con",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17079)","v":1},17073,"J8565",null,"Gefitinib oral",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17081)","v":1},17075,"J8600",null,"Melphalan oral 2 mg",null,0.12,null,0.12,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17103)","v":1},17097,"J9037",null,"Inj belantamab mafodont blmf",null,42.973999999999997,null,42.973999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$B$2,C17128)","v":1},17122,"J9153",null,"Inj daunorubicin, cytarabine",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17140)","v":1},17134,"J9185",null,"Fludarabine phosphate inj",null,75.176000000000002,null,75.176000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17157)","v":1},17151,"J9213",null,"Interferon alfa-2a inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17183)","v":1},17177,"J9270",null,"Plicamycin (mithramycin) inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17200)","v":1},17194,"J9311",null,"Inj rituximab, hyaluronidase",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17226)","v":1},17220,"J9400",null,"Inj, ziv-aflibercept, 1mg",null,7.5229999999999997,null,7.5229999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17229)","v":1},17223,"K0001","NU","Standard wheelchair",null,655.42599999999993,null,655.42599999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17250)","v":1},17244,"K0011","NU","Stnd wt pwr whlchr w control",null,7218.0909999999985,null,7218.0909999999985,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17276)","v":1},17270,"K0040","RR","Adjustable angle footplate",null,6.6830400000000001,null,6.6830400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17297)","v":1},17291,"K0053","NU","Elevate footrest articulate",null,98.328000000000003,null,98.328000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17311)","v":1},17305,"K0108","NU","W/c component-accessory nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17326)","v":1},17320,"K0606",null,"Aed garment w elec analysis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C17354)","v":1},17348,"K0815","RR","Pwc gp 1 std seat/back",null,359.14466016,null,359.14466016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17373)","v":1},17367,"K0828","NU","Pwc gp 2 xtra hd seat/back",null,9405.2044944000008,null,9405.2044944000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17391)","v":1},17385,"K0840","NU","Pwc gp2 xhd sing pow opt s/b",null,11090.762654400001,null,11090.762654400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17402)","v":1},17396,"K0849","RR","Pwc gp 3 std cap chair",null,801.39101327999992,null,801.39101327999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17415)","v":1},17409,"K0856","NU","Pwc gp3 std sing pow opt s/b",null,8947.0057247999994,null,8947.0057247999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17445)","v":1},17439,"K0879","NU","Pwc gp4 hd sing pow opt s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17458)","v":1},17452,"K0898","RR","Power wheelchair noc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17474)","v":1},17468,"K1009","RR","Speech volume modulation sys",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C17501)","v":1},17495,"L0456",null,"Tlso flex trnk sj-ss pre cst",null,1188.829,null,1188.829,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17521)","v":1},17515,"L0621",null,"Sio flex pelvic/sacr pre ots",null,113.3014,null,113.3014,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17524)","v":1},17518,"L0624",null,"Sio panel custom",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C17543)","v":1},17537,"L0643",null,"Lso sag ctr rigi pos pre ots",null,169.33600000000001,null,169.33600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17571)","v":1},17565,"L1040",null,"Lumbar or lumbar rib pad",null,110.49539999999999,null,110.49539999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17586)","v":1},17580,"L1250",null,"Anterior asis pad",null,86.91279999999999,null,86.91279999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17600)","v":1},17594,"L1652",null,"Ho bi thighcuffs w sprdr bar",null,426.08499999999998,null,426.08499999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17623)","v":1},17617,"L1845",null,"Ko double upright pre cst",null,972.02279999999996,null,972.02279999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17647)","v":1},17641,"L1980",null,"Afo sing solid stirrup calf",null,537.48320000000001,null,537.48320000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17666)","v":1},17660,"L2106",null,"Afo tib fx cast plaster mold",null,802.52819999999997,null,802.52819999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17672)","v":1},17666,"L2128",null,"Kafo fem fx cast molded to p",null,2618.0711999999999,null,2618.0711999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17690)","v":1},17684,"L2260",null,"Reinforced solid stirrup",null,229.55519999999999,null,229.55519999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17719)","v":1},17713,"L2525",null,"Th/wght bear nar m-l brim mo",null,1485.8990000000001,null,1485.8990000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17733)","v":1},17727,"L2630",null,"Pelvic control band & belt u",null,299.5222,null,299.5222,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17748)","v":1},17742,"L2820",null,"Soft interface below knee se",null,99.4422,null,99.4422,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17769)","v":1},17763,"L3140",null,"Abduction rotation bar shoe",null,106.43279999999999,null,106.43279999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17794)","v":1},17788,"L3250",null,"Custom mold shoe remov prost",null,319.14209999999997,null,319.14209999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17816)","v":1},17810,"L3410",null,"Shoe metatarsal bar between",null,110.959,null,110.959,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17831)","v":1},17825,"L3540",null,"Ortho shoe add full sole",null,60.8292,null,60.8292,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17845)","v":1},17839,"L3660",null,"So 8 ab rstr can/web pre ots",null,115.16800000000001,null,115.16800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17874)","v":1},17868,"L3908",null,"Who cock-up nonmolde pre ots",null,89.511400000000009,null,89.511400000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17892)","v":1},17886,"L3956",null,"Add joint upper ext orthosis",null,108.489,null,108.489,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17898)","v":1},17892,"L3973",null,"Sewho airplane w/jnt(s) cf",null,2157.8872000000001,null,2157.8872000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C17917)","v":1},17911,"L4055",null,"Replace non-molded calf lace",null,310.55099999999999,null,310.55099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C17941)","v":1},17935,"L5020",null,"Tibial tubercle hgt w/ toe f",null,2867.3044,null,2867.3044,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17964)","v":1},17958,"L5450",null,"Postop app non-wgt bear dsg",null,560.32399999999996,null,560.32399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17984)","v":1},17978,"L5616",null,"Ak univ multiplex sys frict",null,1724.8251000000002,null,1724.8251000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C17993)","v":1},17987,"L5630",null,"Syme typ expandabl wall sckt",null,643.17880000000002,null,643.17880000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18014)","v":1},18008,"L5654",null,"Socket insert symes",null,492.02340000000004,null,492.02340000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18026)","v":1},18020,"L5676",null,"Bk knee joints single axis p",null,536.11779999999999,null,536.11779999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18043)","v":1},18037,"L5697",null,"Ak/knee disartic pelvic band",null,135.9281,null,135.9281,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18063)","v":1},18057,"L5728",null,"Knee-shin fluid swg & stance",null,3285.2614000000003,null,3285.2614000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18090)","v":1},18084,"L5910",null,"Endo below knee alignable sy",null,459.95590000000004,null,459.95590000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18106)","v":1},18100,"L5973",null,"Ank-foot sys dors-plant flex",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18119)","v":1},18113,"L5988",null,"Vertical shock reducing pylo",null,2490.5969999999998,null,2490.5969999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C18149)","v":1},18143,"L6550",null,"Shldr disar prosth tiss shap",null,6038.85,null,6038.85,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18162)","v":1},18156,"L6616",null,"Disconnect insert locking wr",null,98.907600000000002,null,98.907600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18173)","v":1},18167,"L6637",null,"Nudge control elbow lock",null,551.80230000000006,null,551.80230000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18191)","v":1},18185,"L6680",null,"Test sock wrist disart/bel e",null,302.10759999999999,null,302.10759999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18210)","v":1},18204,"L6707",null,"Term dev mech hook vol close",null,1785.9756,null,1785.9756,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C18238)","v":1},18232,"L6940",null,"Elbow disarticulation switch",null,12837.198100000001,null,12837.198100000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18259)","v":1},18253,"L7360",null,"Six volt bat otto bock/eq ea",null,337.0453,null,337.0453,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18277)","v":1},18271,"L7902",null,"Tension ring, vac erect dev",null,25.204608,null,25.204608,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18288)","v":1},18282,"L8035",null,"Custom breast prosthesis",null,4567.5677000000005,null,4567.5677000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18314)","v":1},18308,"L8470",null,"Pros sock single ply bk",null,8.4709000000000003,null,8.4709000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C18335)","v":1},18329,"L8608",null,"Arg ii ext com/sup/acc misc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18338)","v":1},18332,"L8612",null,"Aqueous shunt prosthesis",null,919.77210000000002,null,919.77210000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$B$2,C18364)","v":1},18358,"L8682",null,"Implt neurostim radiofq rec",null,6796.2906999999996,null,6796.2906999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18381)","v":1},18375,"L8701",null,"Pow ue rom dev ewh uprt cust",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18407)","v":1},18401,"M1018",null,"Pt dx hst cr pt sk lg cr scr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18424)","v":1},18418,"M1039",null,"Pt dx lum sp reg inf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18436)","v":1},18430,"M1057",null,"Aspirin not used, no rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18461)","v":1},18455,"M1122",null,"Docu dx degen neuro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18483)","v":1},18477,"P2028",null,"Cephalin floculation test",null,7.0289999999999999,null,7.0289999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C18486)","v":1},18480,"P2033",null,"Blood thymol turbidity",null,7.0289999999999999,null,7.0289999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$B$2,C18509)","v":1},18503,"P9039",null,"Rbc deglycerolized",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C18533)","v":1},18527,"P9100",null,"Pathogen test for platelets",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C18546)","v":1},18540,"Q0092",null,"Set up port xray equipment",null,41.687999999999995,null,41.687999999999995,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$B$2,C18562)","v":1},18556,"Q0173",null,"Trimethobenzamide hcl 250mg",null,2.4500000000000002,null,2.4500000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C18589)","v":1},18583,"Q0495",null,"Charger elec/combo vad, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18609)","v":1},18603,"Q1004",null,"Ntiol category 4",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C18613)","v":1},18607,"Q2017",null,"Teniposide, 50 mg",null,107.83,null,107.83,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C18634)","v":1},18628,"Q4004",null,"Cast sup shoulder cast fbrgl",null,129.85624080000002,null,129.85624080000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C18656)","v":1},18650,"Q4026",null,"Cast sup hip spica fiberglas",null,125.91802080000001,null,125.91802080000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C18681)","v":1},18675,"Q4051",null,"Splint supplies misc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C18693)","v":1},18687,"Q4108",null,"Integra matrix",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C18710)","v":1},18704,"Q4128",null,"Flexhd/allopatchhd/matrixhd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18731)","v":1},18725,"Q4152",null,"Dermapure 1 square cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18760)","v":1},18754,"Q4182",null,"Transcyte, per sq centimeter",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18778)","v":1},18772,"Q4221",null,"Amniowrap2 per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18797)","v":1},18791,"Q4244",null,"Procenta, per 200 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18807)","v":1},18801,"Q5002",null,"Hospice/home hlth in asst lv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18821)","v":1},18815,"Q5113",null,"Inj herzuma 10 mg",null,81.994,null,81.994,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C18850)","v":1},18844,"Q9966",null,"Locm 200-299mg/ml iodine,1ml",null,0.318,null,0.318,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C18864)","v":1},18858,"R0310",null,"Retraining tuition fees",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C18879)","v":1},18873,"S0017",null,"Injection, aminocaproic acid",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18907)","v":1},18901,"S0126",null,"Inj follitropin alfa 75 iu",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18926)","v":1},18920,"S0171",null,"Bumetanide 0.5 mg",null,0.03,null,0.03,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$B$2,C18944)","v":1},18938,"S0207",null,"Paramedicintercep nonhospals",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18955)","v":1},18949,"S0270",null,"Home std case rate 30 days",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18976)","v":1},18970,"S0500",null,"Dispos cont lens",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C18992)","v":1},18986,"S0601",null,"Screening proctoscopy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19005)","v":1},18999,"S1002",null,"Custom item",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19029)","v":1},19023,"S2095",null,"Transcath emboliz microspher",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19052)","v":1},19046,"S2265",null,"Induced abortion 25-28 wks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19072)","v":1},19066,"S3000",null,"Bilat dil retinal exam",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19077)","v":1},19071,"S3630",null,"Eosinophil blood count",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19096)","v":1},19090,"S3865",null,"Comp genet test hyp cardiomy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19124)","v":1},19118,"S4981",null,"Insert levonorgestrel ius",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19139)","v":1},19133,"S5101",null,"Adult day care per half day",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19153)","v":1},19147,"S5131",null,"Homemaker service nos /diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19176)","v":1},19170,"S5502",null,"Hit interim cath care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19200)","v":1},19194,"S8080",null,"Scintimammography",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19221)","v":1},19215,"S8421",null,"Ready gradient sleev/glov",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19224)","v":1},19218,"S8424",null,"Ready gradient sleeve",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19250)","v":1},19244,"S9061",null,"Medical supplies and equipme",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19261)","v":1},19255,"S9125",null,"Respite care, in the home, p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19279)","v":1},19273,"S9326",null,"Hit cont pain per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19304)","v":1},19298,"S9363",null,"Hit anti-spasmotic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19322)","v":1},19316,"S9434",null,"Mod solid food suppl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19347)","v":1},19341,"S9475",null,"Ambulatory setting substance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19369)","v":1},19363,"S9590",null,"Ht irrigation diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19371)","v":1},19365,"S9900",null,"Christian sci pract visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19398)","v":1},19392,"T1009",null,"Child sitting services",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19408)","v":1},19402,"T1020",null,"Personal care ser per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19427)","v":1},19421,"T2002",null,"N-et; per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19451)","v":1},19445,"T2029",null,"Special med equip, noswaiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19463)","v":1},19457,"T2041",null,"Support broker waiver/15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19464)","v":1},19458,"T2042",null,"Hospice routine home care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19465)","v":1},19459,"T2043",null,"Hospice continuous home care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19466)","v":1},19460,"T2044",null,"Hospice respite care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19467)","v":1},19461,"T2045",null,"Hospice general care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19468)","v":1},19462,"T2046",null,"Hospice long term care, r&b",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19469)","v":1},19463,"T2047",null,"Hab prevo waiver per 15",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19470)","v":1},19464,"T2048",null,"Bh ltc res r&b, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19471)","v":1},19465,"T2049",null,"N-et; stretcher van, mileage",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19472)","v":1},19466,"T2101",null,"Breast milk proc/store/dist",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19473)","v":1},19467,"T4521",null,"Adult size brief/diaper sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19474)","v":1},19468,"T4522",null,"Adult size brief/diaper med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19475)","v":1},19469,"T4523",null,"Adult size brief/diaper lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19476)","v":1},19470,"T4524",null,"Adult size brief/diaper xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19477)","v":1},19471,"T4525",null,"Adult size pull-on sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19478)","v":1},19472,"T4526",null,"Adult size pull-on med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19479)","v":1},19473,"T4527",null,"Adult size pull-on lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19480)","v":1},19474,"T4528",null,"Adult size pull-on xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19481)","v":1},19475,"T4529",null,"Ped size brief/diaper sm/med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19482)","v":1},19476,"T4530",null,"Ped size brief/diaper lg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19483)","v":1},19477,"T4531",null,"Ped size pull-on sm/med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19484)","v":1},19478,"T4532",null,"Ped size pull-on lg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19485)","v":1},19479,"T4533",null,"Youth size brief/diaper",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19486)","v":1},19480,"T4534",null,"Youth size pull-on",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19487)","v":1},19481,"T4535",null,"Disposable liner/shield/pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19488)","v":1},19482,"T4536",null,"Reusable pull-on any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19489)","v":1},19483,"T4537",null,"Reusable underpad bed size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19490)","v":1},19484,"T4538",null,"Diaper serv reusable diaper",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19491)","v":1},19485,"T4539",null,"Reuse diaper/brief any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19492)","v":1},19486,"T4540",null,"Reusable underpad chair size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19493)","v":1},19487,"T4541",null,"Large disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19494)","v":1},19488,"T4542",null,"Small disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19495)","v":1},19489,"T4543",null,"Adult disp brief/diap abv xl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19496)","v":1},19490,"T4544",null,"Adlt disp und/pull on abv xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19497)","v":1},19491,"T4545",null,"Incon disposable penile wrap",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19498)","v":1},19492,"T5001",null,"Position seat spec orth need",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19499)","v":1},19493,"T5999",null,"Supply, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19500)","v":1},19494,"U0001",null,"2019-ncov diagnostic p",null,37.712394719999999,null,37.712394719999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19501)","v":1},19495,"U0002",null,"Covid-19 lab test non-cdc",null,53.885351520000007,null,53.885351520000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19502)","v":1},19496,"U0003",null,"SARS-COV-2 DNA/RNA HIGH THROUGHPUT",null,106.5,null,106.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19503)","v":1},19497,"U0004",null,"2019-NCOV ANY TECHNIQUE HIGH THROUGHPUT",null,106.5,null,106.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19504)","v":1},19498,"U0005",null,"Infec agen detec ampli probe",null,35.5,null,35.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19505)","v":1},19499,"V0028",null,"Travel, vocational services, claimant",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
[{"$f":"SEARCH(Lookup!$B$2,C19506)","v":1},19500,"V0028",null,"Travel, vocational services, claimant",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
[{"$f":"SEARCH(Lookup!$B$2,C19507)","v":1},19501,"V2020",null,"Vision svcs frames purchases",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19508)","v":1},19502,"V2025",null,"Eyeglasses delux frames",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19509)","v":1},19503,"V2100",null,"Lens spher single plano 4.00",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19510)","v":1},19504,"V2101",null,"Single visn sphere 4.12-7.00",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19511)","v":1},19505,"V2102",null,"Singl visn sphere 7.12-20.00",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19512)","v":1},19506,"V2103",null,"Spherocylindr 4.00d/12-2.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19513)","v":1},19507,"V2104",null,"Spherocylindr 4.00d/2.12-4d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19514)","v":1},19508,"V2105",null,"Spherocylinder 4.00d/4.25-6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19515)","v":1},19509,"V2106",null,"Spherocylinder 4.00d/>6.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19516)","v":1},19510,"V2107",null,"Spherocylinder 4.25d/12-2d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19517)","v":1},19511,"V2108",null,"Spherocylinder 4.25d/2.12-4d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19518)","v":1},19512,"V2109",null,"Spherocylinder 4.25d/4.25-6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19519)","v":1},19513,"V2110",null,"Spherocylinder 4.25d/over 6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19520)","v":1},19514,"V2111",null,"Spherocylindr 7.25d/.25-2.25",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19521)","v":1},19515,"V2112",null,"Spherocylindr 7.25d/2.25-4d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19522)","v":1},19516,"V2113",null,"Spherocylindr 7.25d/4.25-6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19523)","v":1},19517,"V2114",null,"Spherocylinder over 12.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19524)","v":1},19518,"V2115",null,"Lens lenticular bifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19525)","v":1},19519,"V2118",null,"Lens aniseikonic single",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19526)","v":1},19520,"V2121",null,"Lenticular lens, single",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19527)","v":1},19521,"V2199",null,"Lens single vision not oth c",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19528)","v":1},19522,"V2200",null,"Lens spher bifoc plano 4.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19529)","v":1},19523,"V2201",null,"Lens sphere bifocal 4.12-7.0",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19530)","v":1},19524,"V2202",null,"Lens sphere bifocal 7.12-20.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19531)","v":1},19525,"V2203",null,"Lens sphcyl bifocal 4.00d/.1",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19532)","v":1},19526,"V2204",null,"Lens sphcy bifocal 4.00d/2.1",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19533)","v":1},19527,"V2205",null,"Lens sphcy bifocal 4.00d/4.2",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19534)","v":1},19528,"V2206",null,"Lens sphcy bifocal 4.00d/ove",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19535)","v":1},19529,"V2207",null,"Lens sphcy bifocal 4.25-7d/.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19536)","v":1},19530,"V2208",null,"Lens sphcy bifocal 4.25-7/2.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19537)","v":1},19531,"V2209",null,"Lens sphcy bifocal 4.25-7/4.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19538)","v":1},19532,"V2210",null,"Lens sphcy bifocal 4.25-7/ov",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19539)","v":1},19533,"V2211",null,"Lens sphcy bifo 7.25-12/.25-",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19540)","v":1},19534,"V2212",null,"Lens sphcyl bifo 7.25-12/2.2",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19541)","v":1},19535,"V2213",null,"Lens sphcyl bifo 7.25-12/4.2",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19542)","v":1},19536,"V2214",null,"Lens sphcyl bifocal over 12.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19543)","v":1},19537,"V2215",null,"Lens lenticular bifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19544)","v":1},19538,"V2218",null,"Lens aniseikonic bifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19545)","v":1},19539,"V2219",null,"Lens bifocal seg width over",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19546)","v":1},19540,"V2220",null,"Lens bifocal add over 3.25d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19547)","v":1},19541,"V2221",null,"Lenticular lens, bifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19548)","v":1},19542,"V2299",null,"Lens bifocal speciality",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19549)","v":1},19543,"V2300",null,"Lens sphere trifocal 4.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19550)","v":1},19544,"V2301",null,"Lens sphere trifocal 4.12-7.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19551)","v":1},19545,"V2302",null,"Lens sphere trifocal 7.12-20",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19552)","v":1},19546,"V2303",null,"Lens sphcy trifocal 4.0/.12-",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19553)","v":1},19547,"V2304",null,"Lens sphcy trifocal 4.0/2.25",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19554)","v":1},19548,"V2305",null,"Lens sphcy trifocal 4.0/4.25",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19555)","v":1},19549,"V2306",null,"Lens sphcyl trifocal 4.00/>6",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19556)","v":1},19550,"V2307",null,"Lens sphcy trifocal 4.25-7/.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19557)","v":1},19551,"V2308",null,"Lens sphc trifocal 4.25-7/2.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19558)","v":1},19552,"V2309",null,"Lens sphc trifocal 4.25-7/4.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19559)","v":1},19553,"V2310",null,"Lens sphc trifocal 4.25-7/>6",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19560)","v":1},19554,"V2311",null,"Lens sphc trifo 7.25-12/.25-",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19561)","v":1},19555,"V2312",null,"Lens sphc trifo 7.25-12/2.25",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19562)","v":1},19556,"V2313",null,"Lens sphc trifo 7.25-12/4.25",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19563)","v":1},19557,"V2314",null,"Lens sphcyl trifocal over 12",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19564)","v":1},19558,"V2315",null,"Lens lenticular trifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19565)","v":1},19559,"V2318",null,"Lens aniseikonic trifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19566)","v":1},19560,"V2319",null,"Lens trifocal seg width > 28",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19567)","v":1},19561,"V2320",null,"Lens trifocal add over 3.25d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19568)","v":1},19562,"V2321",null,"Lenticular lens, trifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19569)","v":1},19563,"V2399",null,"Lens trifocal speciality",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19570)","v":1},19564,"V2410",null,"Lens variab asphericity sing",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19571)","v":1},19565,"V2430",null,"Lens variable asphericity bi",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19572)","v":1},19566,"V2499",null,"Variable asphericity lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19573)","v":1},19567,"V2500",null,"Contact lens pmma spherical",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19574)","v":1},19568,"V2501",null,"Cntct lens pmma-toric/prism",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19575)","v":1},19569,"V2502",null,"Contact lens pmma bifocal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19576)","v":1},19570,"V2503",null,"Cntct lens pmma color vision",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19577)","v":1},19571,"V2510",null,"Cntct gas permeable sphericl",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19578)","v":1},19572,"V2511",null,"Cntct toric prism ballast",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19579)","v":1},19573,"V2512",null,"Cntct lens gas permbl bifocl",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19580)","v":1},19574,"V2513",null,"Contact lens extended wear",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19581)","v":1},19575,"V2520",null,"Contact lens hydrophilic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19582)","v":1},19576,"V2521",null,"Cntct lens hydrophilic toric",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19583)","v":1},19577,"V2522",null,"Cntct lens hydrophil bifocl",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19584)","v":1},19578,"V2523",null,"Cntct lens hydrophil extend",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19585)","v":1},19579,"V2524",null,"Cntct lens hydrophil photoch",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19586)","v":1},19580,"V2530",null,"Contact lens gas impermeable",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19587)","v":1},19581,"V2531",null,"Contact lens gas permeable",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19588)","v":1},19582,"V2599",null,"Contact lens/es other type",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19589)","v":1},19583,"V2600",null,"Hand held low vision aids",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19590)","v":1},19584,"V2610",null,"Single lens spectacle mount",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19591)","v":1},19585,"V2615",null,"Telescop/othr compound lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19592)","v":1},19586,"V2623",null,"Plastic eye prosth custom",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19593)","v":1},19587,"V2624",null,"Polishing artifical eye",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19594)","v":1},19588,"V2625",null,"Enlargemnt of eye prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19595)","v":1},19589,"V2626",null,"Reduction of eye prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19596)","v":1},19590,"V2627",null,"Scleral cover shell",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19597)","v":1},19591,"V2628",null,"Fabrication & fitting",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19598)","v":1},19592,"V2629",null,"Prosthetic eye other type",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19599)","v":1},19593,"V2630",null,"Anter chamber intraocul lens",null,122.2572,null,122.2572,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C19600)","v":1},19594,"V2631",null,"Iris support intraoclr lens",null,122.2572,null,122.2572,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C19601)","v":1},19595,"V2632",null,"Post chmbr intraocular lens",null,122.2572,null,122.2572,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C19602)","v":1},19596,"V2700",null,"Balance lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19603)","v":1},19597,"V2702",null,"Deluxe lens feature",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19604)","v":1},19598,"V2710",null,"Glass/plastic slab off prism",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19605)","v":1},19599,"V2715",null,"Prism lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19606)","v":1},19600,"V2718",null,"Fresnell prism press-on lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19607)","v":1},19601,"V2730",null,"Special base curve",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19608)","v":1},19602,"V2744",null,"Tint photochromatic lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19609)","v":1},19603,"V2745",null,"Tint, any color/solid/grad",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19610)","v":1},19604,"V2750",null,"Anti-reflective coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19611)","v":1},19605,"V2755",null,"Uv lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19612)","v":1},19606,"V2756",null,"Eye glass case",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19613)","v":1},19607,"V2760",null,"Scratch resistant coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19614)","v":1},19608,"V2761",null,"Mirror coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19615)","v":1},19609,"V2762",null,"Polarization, any lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19616)","v":1},19610,"V2770",null,"Occluder lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19617)","v":1},19611,"V2780",null,"Oversize lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19618)","v":1},19612,"V2781",null,"Progressive lens per lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19619)","v":1},19613,"V2782",null,"Lens, 1.54-1.65 p/1.60-1.79g",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19620)","v":1},19614,"V2783",null,"Lens, >= 1.66 p/>=1.80 g",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19621)","v":1},19615,"V2784",null,"Lens polycarb or equal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19622)","v":1},19616,"V2785",null,"Corneal tissue processing",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19623)","v":1},19617,"V2786",null,"Occupational multifocal lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19624)","v":1},19618,"V2787",null,"Astigmatism-correct function",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19625)","v":1},19619,"V2788",null,"Presbyopia-correct function",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19626)","v":1},19620,"V2790",null,"Amniotic membrane",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19627)","v":1},19621,"V2797",null,"Vis item/svc in other code",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19628)","v":1},19622,"V2799",null,"Misc vision item or service",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19629)","v":1},19623,"V5008",null,"Hearing screening",null,87.300307016207981,null,87.300307016207981,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19630)","v":1},19624,"V5010",null,"Assessment for hearing aid",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19631)","v":1},19625,"V5011",null,"Hearing aid fitting/checking",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19632)","v":1},19626,"V5014",null,"Hearing aid repair/modifying",null,58.203775680336001,null,58.203775680336001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C19633)","v":1},19627,"V5020",null,"Conformity evaluation",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$B$2,C19634)","v":1},19628,"V5030",null,"Body-worn hearing aid air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19635)","v":1},19629,"V5040",null,"Body-worn hearing aid bone",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19636)","v":1},19630,"V5050",null,"Hearing aid monaural in ear",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19637)","v":1},19631,"V5060",null,"Behind ear hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19638)","v":1},19632,"V5070",null,"Glasses air conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19639)","v":1},19633,"V5080",null,"Glasses bone conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19640)","v":1},19634,"V5090",null,"Hearing aid dispensing fee",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19641)","v":1},19635,"V5095",null,"Implant mid ear hearing pros",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19642)","v":1},19636,"V5100",null,"Body-worn bilat hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19643)","v":1},19637,"V5110",null,"Hearing aid dispensing fee",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19644)","v":1},19638,"V5120",null,"Body-worn binaur hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19645)","v":1},19639,"V5130",null,"In ear binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19646)","v":1},19640,"V5140",null,"Behind ear binaur hearing ai",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19647)","v":1},19641,"V5150",null,"Glasses binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19648)","v":1},19642,"V5160",null,"Dispensing fee binaural",null,1652.9529476940481,null,1652.9529476940481,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19649)","v":1},19643,"V5171",null,"Hearing aid monaural ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19650)","v":1},19644,"V5172",null,"Hearing aid monaural itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19651)","v":1},19645,"V5181",null,"Hearing aid monaural bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19652)","v":1},19646,"V5190",null,"Hearing aid monaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19653)","v":1},19647,"V5200",null,"Disp fee contralateral monau",null,990.73903458816005,null,990.73903458816005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19654)","v":1},19648,"V5211",null,"Hearing aid binaural ite/ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19655)","v":1},19649,"V5212",null,"Hearing aid binaural ite/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19656)","v":1},19650,"V5213",null,"Hearing aid binaural ite/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19657)","v":1},19651,"V5214",null,"Hearing aid binaural itc/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19658)","v":1},19652,"V5215",null,"Hearing aid binaural itc/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19659)","v":1},19653,"V5221",null,"Hearing aid binaural bte/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19660)","v":1},19654,"V5230",null,"Hearing aid binaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19661)","v":1},19655,"V5240",null,"Disp fee contralateral binau",null,990.73903458816005,null,990.73903458816005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19662)","v":1},19656,"V5241",null,"Dispensing fee, monaural",null,826.47647384702407,null,826.47647384702407,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19663)","v":1},19657,"V5242",null,"Hearing aid, monaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19664)","v":1},19658,"V5243",null,"Hearing aid, monaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19665)","v":1},19659,"V5244",null,"Hearing aid, prog, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19666)","v":1},19660,"V5245",null,"Hearing aid, prog, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19667)","v":1},19661,"V5246",null,"Hearing aid, prog, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19668)","v":1},19662,"V5247",null,"Hearing aid, prog, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19669)","v":1},19663,"V5248",null,"Hearing aid, binaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19670)","v":1},19664,"V5249",null,"Hearing aid, binaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19671)","v":1},19665,"V5250",null,"Hearing aid, prog, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19672)","v":1},19666,"V5251",null,"Hearing aid, prog, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19673)","v":1},19667,"V5252",null,"Hearing aid, prog, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19674)","v":1},19668,"V5253",null,"Hearing aid, prog, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19675)","v":1},19669,"V5254",null,"Hearing id, digit, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19676)","v":1},19670,"V5255",null,"Hearing aid, digit, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19677)","v":1},19671,"V5256",null,"Hearing aid, digit, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19678)","v":1},19672,"V5257",null,"Hearing aid, digit, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19679)","v":1},19673,"V5258",null,"Hearing aid, digit, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19680)","v":1},19674,"V5259",null,"Hearing aid, digit, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19681)","v":1},19675,"V5260",null,"Hearing aid, digit, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19682)","v":1},19676,"V5261",null,"Hearing aid, digit, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$B$2,C19683)","v":1},19677,"V5262",null,"Hearing aid, disp, monaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19684)","v":1},19678,"V5263",null,"Hearing aid, disp, binaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19685)","v":1},19679,"V5264",null,"Ear mold/insert",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C19686)","v":1},19680,"V5265",null,"Ear mold/insert, disp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19687)","v":1},19681,"V5266",null,"Battery for hearing device",null,1.0177358162400001,null,1.0177358162400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$B$2,C19688)","v":1},19682,"V5267",null,"Hearing aid sup/access/dev",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$B$2,C19689)","v":1},19683,"V5268",null,"Ald telephone amplifier",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19690)","v":1},19684,"V5269",null,"Alerting device, any type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19691)","v":1},19685,"V5270",null,"Ald, tv amplifier, any type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19692)","v":1},19686,"V5271",null,"Ald, tv caption decoder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19693)","v":1},19687,"V5272",null,"Tdd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19694)","v":1},19688,"V5273",null,"Ald for cochlear implant",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19695)","v":1},19689,"V5274",null,"Ald unspecified",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19696)","v":1},19690,"V5275",null,"Ear impression",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19697)","v":1},19691,"V5281",null,"Ald fm/dm system, monaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19698)","v":1},19692,"V5282",null,"Ald fm/dm system binaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19699)","v":1},19693,"V5283",null,"Ald neck, loop ind receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19700)","v":1},19694,"V5284",null,"Ald fm/dm ear level receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19701)","v":1},19695,"V5285",null,"Ald fm/dm aud input receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19702)","v":1},19696,"V5286",null,"Ald blu tooth fm/dm receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19703)","v":1},19697,"V5287",null,"Ald fm/dm receiver, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19704)","v":1},19698,"V5288",null,"Ald fm/dm transmitter ald",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19705)","v":1},19699,"V5289",null,"Ald fm/dm adapt/boot couplin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19706)","v":1},19700,"V5290",null,"Ald transmitter microphone",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19707)","v":1},19701,"V5298",null,"Hearing aid noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19708)","v":1},19702,"V5299",null,"Hearing service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$B$2,C19709)","v":1},19703,"V5336",null,"Repair communication device",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19710)","v":1},19704,"V5362",null,"Speech screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19711)","v":1},19705,"V5363",null,"Language screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$B$2,C19712)","v":1},19706,"V5364",null,"Dysphagia screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]

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[null,null,null,null,"Professional Services Fee Schedule"]
[]
[]
[]
[null,null,null,null,null,null,null,null,"DOLLAR VALUE",null,null,null,null,"MODIFIERS"]
[null,null,null,null,"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A7=1,IF(F7=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A7=1,IF(F7=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10004,null,"See CPT",null,89.165999999999997,null,73.533000000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A8=1,IF(F8=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A8=1,IF(F8=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10005,null,"See CPT",null,242.02199999999999,null,122.748,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9=1,IF(F9=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10006,null,"See CPT",null,105.378,null,85.691999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10=1,IF(F10=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10007,null,"See CPT",null,562.20900000000006,null,155.751,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11=1,IF(F11=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10008,null,"See CPT",null,297.02699999999999,null,99.587999999999994,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12=1,IF(F12=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10009,null,"See CPT",null,863.28899999999999,null,189.91199999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13=1,IF(F13=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10010,null,"See CPT",null,505.46699999999998,null,136.64399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14=1,IF(F14=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15=1,IF(F15=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16=1,IF(F16=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10021,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17=1,IF(F17=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10030,null,"See CPT",null,1208.373,null,229.863,null,"000",0,0,0,9,2,9,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18=1,IF(F18=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10035,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19=1,IF(F19=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10036,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E20,1)","v":1},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F20,1)","v":{"$error":"#VALUE!"}},1,{"$f":"IF(A20=1,IF(F20=Lookup!$A$13,2))","v":2},10040,null,"See CPT",null,206.70299999999997,null,88.007999999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E21,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F21,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A21=1,IF(F21=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10060,null,"See CPT",null,219.441,null,180.648,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E22,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F22,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A22=1,IF(F22=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10061,null,"See CPT",null,372.87600000000003,null,317.87099999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E23,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F23,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A23=1,IF(F23=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10080,null,"See CPT",null,450.46199999999999,null,185.28,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E24,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F24,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A24=1,IF(F24=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10081,null,"See CPT",null,613.74,null,299.92199999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E25,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F25,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A25=1,IF(F25=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10120,null,"See CPT",null,275.60399999999998,null,182.964,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E26,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F26,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A26=1,IF(F26=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10121,null,"See CPT",null,481.72800000000001,null,319.60799999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E27,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F27,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A27=1,IF(F27=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10140,null,"See CPT",null,305.13299999999998,null,206.124,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E28,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F28,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A28=1,IF(F28=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10160,null,"See CPT",null,231.6,null,165.01500000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E29,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F29,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A29=1,IF(F29=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},10180,null,"See CPT",null,469.56899999999996,null,309.76499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E30,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F30,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A30=1,IF(F30=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11000,null,"See CPT",null,102.483,null,46.899000000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E31,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F31,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A31=1,IF(F31=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11001,null,"See CPT",null,44.003999999999998,null,23.16,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E32,1)","v":2},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F32,1)","v":{"$error":"#VALUE!"}},false,{"$f":"IF(A32=1,IF(F32=Lookup!$A$13,2))","v":false},11004,null,"See CPT",null,974.45699999999988,null,974.45699999999988,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E33,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F33,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A33=1,IF(F33=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11005,null,"See CPT",null,1318.383,null,1318.383,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E34,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F34,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A34=1,IF(F34=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11006,null,"See CPT",null,1195.635,null,1195.635,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E35,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F35,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A35=1,IF(F35=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11008,null,"See CPT",null,464.35799999999995,null,464.35799999999995,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E36,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F36,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A36=1,IF(F36=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11010,null,"See CPT",null,839.55,null,471.88499999999999,null,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E37,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F37,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A37=1,IF(F37=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11011,null,"See CPT",null,925.82100000000003,null,509.52000000000004,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E38,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F38,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A38=1,IF(F38=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11012,null,"See CPT",null,1180.5809999999999,null,709.27499999999998,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E39,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F39,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A39=1,IF(F39=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11042,null,"See CPT",null,233.916,null,103.64100000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E40,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F40,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A40=1,IF(F40=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11043,null,"See CPT",null,416.30099999999999,null,264.60300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E41,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F41,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A41=1,IF(F41=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11044,null,"See CPT",null,545.99699999999996,null,383.298,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E42,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F42,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A42=1,IF(F42=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11045,null,"See CPT",null,72.375,null,44.003999999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E43,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F43,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A43=1,IF(F43=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11046,null,"See CPT",null,127.95899999999999,null,93.798000000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E44,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F44,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A44=1,IF(F44=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11047,null,"See CPT",null,210.756,null,165.01500000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E45,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F45,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A45=1,IF(F45=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11055,null,"See CPT",null,125.64299999999999,null,26.634,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E46,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F46,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A46=1,IF(F46=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11056,null,"See CPT",null,143.59199999999998,null,37.634999999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E47,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F47,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A47=1,IF(F47=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11057,null,"See CPT",null,157.488,null,49.214999999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E48,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F48,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A48=1,IF(F48=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11102,null,"See CPT",null,187.017,null,64.269000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E49,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F49,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A49=1,IF(F49=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11103,null,"See CPT",null,93.798000000000002,null,37.055999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E50,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F50,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A50=1,IF(F50=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11104,null,"See CPT",null,232.17899999999997,null,79.901999999999987,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E51,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F51,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A51=1,IF(F51=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11105,null,"See CPT",null,108.27300000000001,null,44.003999999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E52,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F52,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A52=1,IF(F52=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11106,null,"See CPT",null,284.86799999999999,null,97.271999999999991,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E53,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F53,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A53=1,IF(F53=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11107,null,"See CPT",null,130.27500000000001,null,53.268000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E54,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F54,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A54=1,IF(F54=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11200,null,"See CPT",null,159.80399999999997,null,131.43299999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E55,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F55,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A55=1,IF(F55=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11201,null,"See CPT",null,31.266000000000002,null,27.791999999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E56,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F56,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A56=1,IF(F56=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11300,null,"See CPT",null,186.43800000000002,null,57.9,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E57,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F57,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A57=1,IF(F57=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11301,null,"See CPT",null,222.33599999999998,null,86.85,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E58,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F58,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A58=1,IF(F58=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11302,null,"See CPT",null,253.60199999999998,null,101.325,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E59,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F59,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A59=1,IF(F59=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11303,null,"See CPT",null,278.49899999999997,null,119.85299999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E60,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F60,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A60=1,IF(F60=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11305,null,"See CPT",null,194.54399999999998,null,64.847999999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E61,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F61,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A61=1,IF(F61=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11306,null,"See CPT",null,224.07300000000001,null,83.954999999999998,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E62,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F62,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A62=1,IF(F62=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11307,null,"See CPT",null,258.23399999999998,null,107.694,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E63,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F63,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A63=1,IF(F63=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11308,null,"See CPT",null,273.28799999999995,null,121.011,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E64,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F64,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A64=1,IF(F64=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11310,null,"See CPT",null,213.072,null,77.585999999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E65,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F65,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A65=1,IF(F65=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11311,null,"See CPT",null,249.54899999999998,null,106.536,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E66,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F66,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A66=1,IF(F66=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11312,null,"See CPT",null,284.28899999999999,null,125.64299999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E67,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F67,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A67=1,IF(F67=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11313,null,"See CPT",null,329.45100000000002,null,163.27799999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E68,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F68,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A68=1,IF(F68=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11400,null,"See CPT",null,232.17899999999997,null,145.32899999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E69,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F69,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A69=1,IF(F69=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11401,null,"See CPT",null,279.65699999999998,null,182.38499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E70,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F70,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A70=1,IF(F70=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11402,null,"See CPT",null,307.44899999999996,null,199.755,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E71,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F71,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A71=1,IF(F71=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11403,null,"See CPT",null,353.76900000000001,null,257.07600000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E72,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F72,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A72=1,IF(F72=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A72=1,IF(F72=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11404,null,"See CPT",null,402.40499999999997,null,283.13099999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E73,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F73,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A73=1,IF(F73=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11406,null,"See CPT",null,565.68299999999999,null,426.72300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E74,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F74,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A74=1,IF(F74=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11420,null,"See CPT",null,231.6,null,143.01300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E75,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F75,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A75=1,IF(F75=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11421,null,"See CPT",null,287.18399999999997,null,188.75399999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E76,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F76,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A76=1,IF(F76=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11422,null,"See CPT",null,322.50299999999999,null,235.07399999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E77,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F77,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A77=1,IF(F77=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11423,null,"See CPT",null,366.50700000000001,null,269.81400000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E78,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F78,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A78=1,IF(F78=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11424,null,"See CPT",null,419.19600000000003,null,306.291,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E79,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F79,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A79=1,IF(F79=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11426,null,"See CPT",null,595.21199999999999,null,473.04300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E80,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F80,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A80=1,IF(F80=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11440,null,"See CPT",null,258.23399999999998,null,183.54299999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E81,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F81,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A81=1,IF(F81=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11441,null,"See CPT",null,311.50200000000001,null,228.126,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E82,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F82,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A82=1,IF(F82=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11442,null,"See CPT",null,344.505,null,252.44400000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E83,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F83,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A83=1,IF(F83=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11443,null,"See CPT",null,407.03699999999998,null,308.02800000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E84,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F84,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A84=1,IF(F84=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11444,null,"See CPT",null,504.88800000000003,null,389.66700000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E85,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F85,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A85=1,IF(F85=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11446,null,"See CPT",null,686.69399999999996,null,554.68200000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E86,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F86,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A86=1,IF(F86=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11450,null,"See CPT",null,775.28100000000006,null,451.041,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E87,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F87,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A87=1,IF(F87=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11451,null,"See CPT",null,946.66500000000008,null,569.73599999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E88,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F88,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A88=1,IF(F88=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11462,null,"See CPT",null,750.38400000000001,null,427.30199999999996,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E89,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F89,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A89=1,IF(F89=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11463,null,"See CPT",null,957.66599999999994,null,572.05200000000002,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E90,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F90,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A90=1,IF(F90=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11470,null,"See CPT",null,814.07399999999996,null,492.72899999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E91,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F91,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A91=1,IF(F91=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11471,null,"See CPT",null,977.93100000000004,null,604.476,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E92,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F92,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A92=1,IF(F92=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11600,null,"See CPT",null,360.71700000000004,null,211.91400000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E93,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F93,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A93=1,IF(F93=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11601,null,"See CPT",null,411.66899999999998,null,255.339,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E94,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F94,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A94=1,IF(F94=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11602,null,"See CPT",null,438.303,null,275.60399999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E95,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F95,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A95=1,IF(F95=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11603,null,"See CPT",null,496.20300000000003,null,328.87199999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E96,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F96,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A96=1,IF(F96=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11604,null,"See CPT",null,553.524,null,363.03299999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E97,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F97,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A97=1,IF(F97=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11606,null,"See CPT",null,789.17700000000002,null,541.36500000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E98,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F98,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A98=1,IF(F98=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11620,null,"See CPT",null,361.875,null,213.072,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E99,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F99,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A99=1,IF(F99=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11621,null,"See CPT",null,412.827,null,255.91799999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E100,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F100,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A100=1,IF(F100=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11622,null,"See CPT",null,452.77800000000002,null,289.5,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E101,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F101,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A101=1,IF(F101=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11623,null,"See CPT",null,526.89,null,357.822,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E102,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F102,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A102=1,IF(F102=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11624,null,"See CPT",null,600.42299999999989,null,407.61599999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E103,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F103,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A103=1,IF(F103=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11626,null,"See CPT",null,722.59199999999998,null,500.83500000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E104,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F104,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A104=1,IF(F104=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11640,null,"See CPT",null,369.40199999999999,null,218.28299999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E105,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F105,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A105=1,IF(F105=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11641,null,"See CPT",null,426.72300000000001,null,266.33999999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E106,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F106,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A106=1,IF(F106=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11642,null,"See CPT",null,478.83299999999997,null,310.923,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E107,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F107,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A107=1,IF(F107=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11643,null,"See CPT",null,562.20900000000006,null,389.66700000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E108,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F108,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A108=1,IF(F108=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11644,null,"See CPT",null,690.74699999999996,null,483.46499999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E109,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F109,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A109=1,IF(F109=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11646,null,"See CPT",null,893.976,null,669.90300000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E110,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F110,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A110=1,IF(F110=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11719,null,"See CPT",null,24.317999999999998,null,12.738,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E111,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F111,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A111=1,IF(F111=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11720,null,"See CPT",null,57.320999999999998,null,24.317999999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E112,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F112,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A112=1,IF(F112=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11721,null,"See CPT",null,78.165000000000006,null,41.108999999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E113,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F113,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A113=1,IF(F113=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11730,null,"See CPT",null,207.86099999999999,null,91.481999999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E114,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F114,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A114=1,IF(F114=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11732,null,"See CPT",null,59.637,null,28.95,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E115,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F115,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A115=1,IF(F115=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11740,null,"See CPT",null,100.746,null,54.425999999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E116,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F116,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A116=1,IF(F116=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11750,null,"See CPT",null,287.76299999999998,null,175.43699999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E117,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F117,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A117=1,IF(F117=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11755,null,"See CPT",null,225.23099999999999,null,103.64100000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E118,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F118,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A118=1,IF(F118=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11760,null,"See CPT",null,347.97899999999998,null,196.85999999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E119,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F119,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A119=1,IF(F119=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11762,null,"See CPT",null,526.89,null,327.13499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E120,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F120,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A120=1,IF(F120=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11765,null,"See CPT",null,304.55399999999997,null,160.38300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E121,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F121,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A121=1,IF(F121=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11770,null,"See CPT",null,627.05700000000002,null,322.50299999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E122,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F122,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A122=1,IF(F122=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11771,null,"See CPT",null,1116.3120000000001,null,774.702,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E123,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F123,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A123=1,IF(F123=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11772,null,"See CPT",null,1378.02,null,1024.83,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E124,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F124,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A124=1,IF(F124=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11900,null,"See CPT",null,99.587999999999994,null,50.372999999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E125,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F125,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A125=1,IF(F125=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11901,null,"See CPT",null,122.16899999999998,null,77.585999999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E126,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F126,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A126=1,IF(F126=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11920,null,"See CPT",null,344.505,null,189.333,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E127,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F127,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A127=1,IF(F127=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11921,null,"See CPT",null,388.50900000000001,null,222.91499999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E128,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F128,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A128=1,IF(F128=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11922,null,"See CPT",null,106.536,null,49.214999999999996,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E129,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F129,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A129=1,IF(F129=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11950,null,"See CPT",null,139.53900000000002,null,88.007999999999996,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E130,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F130,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A130=1,IF(F130=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11951,null,"See CPT",null,186.43800000000002,null,125.06400000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E131,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F131,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A131=1,IF(F131=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11952,null,"See CPT",null,249.54899999999998,null,175.43699999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E132,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F132,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A132=1,IF(F132=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11954,null,"See CPT",null,274.44600000000003,null,191.649,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E133,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F133,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A133=1,IF(F133=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11960,null,"See CPT",null,1783.8989999999999,null,1783.8989999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E134,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F134,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A134=1,IF(F134=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11970,null,"See CPT",null,971.56200000000001,null,971.56200000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E135,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F135,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A135=1,IF(F135=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11971,null,"See CPT",null,950.13900000000001,null,950.13900000000001,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E136,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F136,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A136=1,IF(F136=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A136=1,IF(F136=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11976,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E137,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F137,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A137=1,IF(F137=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11980,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E138,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F138,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A138=1,IF(F138=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11981,null,"See CPT",null,182.38499999999999,null,108.27300000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E139,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F139,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A139=1,IF(F139=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11982,null,"See CPT",null,206.70299999999997,null,127.95899999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E140,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F140,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A140=1,IF(F140=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},11983,null,"See CPT",null,254.76000000000002,null,177.17400000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E141,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F141,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A141=1,IF(F141=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12001,null,"See CPT",null,169.64699999999999,null,75.849000000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E142,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F142,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A142=1,IF(F142=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12002,null,"See CPT",null,203.22899999999998,null,100.746,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E143,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F143,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A143=1,IF(F143=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12004,null,"See CPT",null,235.65300000000002,null,125.06400000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E144,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F144,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A144=1,IF(F144=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12005,null,"See CPT",null,313.23899999999998,null,162.11999999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E145,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F145,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A145=1,IF(F145=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12006,null,"See CPT",null,365.928,null,199.17599999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E146,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F146,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A146=1,IF(F146=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12007,null,"See CPT",null,412.24799999999999,null,247.23299999999998,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E147,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F147,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A147=1,IF(F147=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12011,null,"See CPT",null,203.22899999999998,null,94.955999999999989,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E148,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F148,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A148=1,IF(F148=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12013,null,"See CPT",null,210.756,null,99.009,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E149,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F149,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A149=1,IF(F149=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12014,null,"See CPT",null,255.91799999999998,null,126.80099999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E150,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F150,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A150=1,IF(F150=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12015,null,"See CPT",null,307.44899999999996,null,159.80399999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E151,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F151,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A151=1,IF(F151=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12016,null,"See CPT",null,390.24599999999998,null,218.28299999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E152,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F152,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A152=1,IF(F152=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12017,null,"See CPT",null,258.81299999999999,null,258.81299999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E153,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F153,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A153=1,IF(F153=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12018,null,"See CPT",null,292.97399999999999,null,292.97399999999999,null,"000",0,0,0,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E154,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F154,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A154=1,IF(F154=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12020,null,"See CPT",null,539.62800000000004,null,325.39800000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E155,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F155,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A155=1,IF(F155=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12021,null,"See CPT",null,310.923,null,244.33799999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E156,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F156,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A156=1,IF(F156=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12031,null,"See CPT",null,473.04300000000001,null,259.971,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E157,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F157,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A157=1,IF(F157=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12032,null,"See CPT",null,548.31299999999999,null,325.39800000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E158,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F158,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A158=1,IF(F158=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12034,null,"See CPT",null,597.52800000000002,null,352.03199999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E159,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F159,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A159=1,IF(F159=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12035,null,"See CPT",null,707.53800000000001,null,415.14299999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E160,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F160,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A160=1,IF(F160=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12036,null,"See CPT",null,777.59699999999998,null,487.51799999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E161,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F161,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A161=1,IF(F161=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12037,null,"See CPT",null,866.76300000000003,null,563.36699999999996,null,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E162,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F162,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A162=1,IF(F162=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12041,null,"See CPT",null,475.93800000000005,null,250.12800000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E163,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F163,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A163=1,IF(F163=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12042,null,"See CPT",null,552.36599999999999,null,335.24099999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E164,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F164,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A164=1,IF(F164=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12044,null,"See CPT",null,686.69399999999996,null,366.50700000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E165,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F165,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A165=1,IF(F165=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12045,null,"See CPT",null,736.48800000000006,null,469.56899999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E166,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F166,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A166=1,IF(F166=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12046,null,"See CPT",null,905.55600000000004,null,549.471,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E167,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F167,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A167=1,IF(F167=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12047,null,"See CPT",null,987.19500000000005,null,610.84500000000003,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E168,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F168,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A168=1,IF(F168=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12051,null,"See CPT",null,509.52000000000004,null,291.23700000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E169,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F169,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A169=1,IF(F169=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12052,null,"See CPT",null,561.63,null,341.61,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E170,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F170,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A170=1,IF(F170=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12053,null,"See CPT",null,657.16499999999996,null,367.08599999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E171,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F171,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A171=1,IF(F171=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12054,null,"See CPT",null,697.11599999999999,null,375.77100000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E172,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F172,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A172=1,IF(F172=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12055,null,"See CPT",null,914.24099999999987,null,517.04700000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E173,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F173,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A173=1,IF(F173=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12056,null,"See CPT",null,1039.3049999999998,null,662.95499999999993,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E174,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F174,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A174=1,IF(F174=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},12057,null,"See CPT",null,1098.3629999999998,null,725.48699999999997,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E175,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F175,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A175=1,IF(F175=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13100,null,"See CPT",null,618.37199999999996,null,344.505,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E176,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F176,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A176=1,IF(F176=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13101,null,"See CPT",null,720.27599999999995,null,428.46000000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E177,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F177,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A177=1,IF(F177=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13102,null,"See CPT",null,210.17699999999999,null,122.16899999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E178,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F178,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A178=1,IF(F178=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13120,null,"See CPT",null,642.68999999999994,null,402.98399999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E179,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F179,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A179=1,IF(F179=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13121,null,"See CPT",null,769.49099999999999,null,440.61900000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E180,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F180,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A180=1,IF(F180=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13122,null,"See CPT",null,228.126,null,140.11799999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E181,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F181,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A181=1,IF(F181=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13131,null,"See CPT",null,698.85299999999995,null,413.98500000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E182,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F182,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A182=1,IF(F182=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13132,null,"See CPT",null,847.65600000000006,null,516.46799999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E183,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F183,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A183=1,IF(F183=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13133,null,"See CPT",null,298.185,null,213.65099999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E184,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F184,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A184=1,IF(F184=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13151,null,"See CPT",null,759.64799999999991,null,477.096,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E185,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F185,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A185=1,IF(F185=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13152,null,"See CPT",null,892.23900000000003,null,573.21,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E186,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F186,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A186=1,IF(F186=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13153,null,"See CPT",null,328.87199999999996,null,233.33700000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E187,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F187,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A187=1,IF(F187=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},13160,null,"See CPT",null,1376.2829999999999,null,1376.2829999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E188,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F188,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A188=1,IF(F188=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14000,null,"See CPT",null,1115.7329999999999,null,865.02599999999995,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E189,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F189,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A189=1,IF(F189=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14001,null,"See CPT",null,1415.076,null,1119.7860000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E190,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F190,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A190=1,IF(F190=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14020,null,"See CPT",null,1229.2170000000001,null,970.40400000000011,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E191,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F191,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A191=1,IF(F191=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14021,null,"See CPT",null,1510.6109999999999,null,1213.5840000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E192,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F192,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A192=1,IF(F192=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14040,null,"See CPT",null,1325.9099999999999,null,1069.413,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E193,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F193,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A193=1,IF(F193=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14041,null,"See CPT",null,1606.146,null,1302.75,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E194,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F194,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A194=1,IF(F194=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14060,null,"See CPT",null,1337.49,null,1138.3140000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E195,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F195,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A195=1,IF(F195=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14061,null,"See CPT",null,1731.789,null,1398.864,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E196,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F196,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A196=1,IF(F196=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14301,null,"See CPT",null,1900.278,null,1489.7670000000001,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E197,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F197,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A197=1,IF(F197=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14302,null,"See CPT",null,368.24400000000003,null,368.24400000000003,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E198,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F198,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A198=1,IF(F198=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},14350,null,"See CPT",null,1171.896,null,1171.896,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E199,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F199,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A199=1,IF(F199=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15002,null,"See CPT",null,626.47799999999995,null,376.34999999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E200,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F200,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A200=1,IF(F200=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A200=1,IF(F200=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15003,null,"See CPT",null,126.80099999999999,null,77.007000000000005,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E201,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F201,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A201=1,IF(F201=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15004,null,"See CPT",null,710.43299999999999,null,447.56700000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E202,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F202,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A202=1,IF(F202=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15005,null,"See CPT",null,208.44,null,154.01400000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E203,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F203,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A203=1,IF(F203=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15040,null,"See CPT",null,489.83400000000006,null,213.072,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E204,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F204,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A204=1,IF(F204=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15050,null,"See CPT",null,1063.0439999999999,null,805.38900000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E205,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F205,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A205=1,IF(F205=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15100,null,"See CPT",null,1532.6129999999998,null,1235.0069999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E206,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F206,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A206=1,IF(F206=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15101,null,"See CPT",null,341.61,null,193.965,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E207,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F207,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A207=1,IF(F207=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15110,null,"See CPT",null,1438.8150000000001,null,1206.636,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E208,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F208,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A208=1,IF(F208=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15111,null,"See CPT",null,192.80699999999999,null,172.542,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E209,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F209,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A209=1,IF(F209=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15115,null,"See CPT",null,1417.9709999999998,null,1192.74,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E210,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F210,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A210=1,IF(F210=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15116,null,"See CPT",null,282.55199999999996,null,255.339,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E211,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F211,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A211=1,IF(F211=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15120,null,"See CPT",null,1496.136,null,1191.5819999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E212,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F212,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A212=1,IF(F212=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15121,null,"See CPT",null,381.56099999999998,null,233.916,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E213,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F213,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A213=1,IF(F213=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15130,null,"See CPT",null,1280.1689999999999,null,1034.0940000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E214,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F214,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A214=1,IF(F214=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15131,null,"See CPT",null,167.91,null,153.435,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E215,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F215,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A215=1,IF(F215=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15135,null,"See CPT",null,1547.088,null,1309.6980000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E216,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F216,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A216=1,IF(F216=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15136,null,"See CPT",null,165.59399999999999,null,153.435,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E217,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F217,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A217=1,IF(F217=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15150,null,"See CPT",null,1241.376,null,1106.4690000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E218,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F218,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A218=1,IF(F218=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15151,null,"See CPT",null,203.80799999999999,null,186.43800000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E219,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F219,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A219=1,IF(F219=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15152,null,"See CPT",null,250.12800000000001,null,233.33700000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E220,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F220,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A220=1,IF(F220=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15155,null,"See CPT",null,1393.0739999999998,null,1259.904,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E221,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F221,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A221=1,IF(F221=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15156,null,"See CPT",null,273.28799999999995,null,255.91799999999998,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E222,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F222,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A222=1,IF(F222=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15157,null,"See CPT",null,303.97499999999997,null,279.07800000000003,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E223,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F223,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A223=1,IF(F223=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15200,null,"See CPT",null,1477.6079999999999,null,1159.1579999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E224,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F224,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A224=1,IF(F224=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15201,null,"See CPT",null,260.55,null,130.85399999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E225,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F225,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A225=1,IF(F225=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15220,null,"See CPT",null,1356.597,null,1050.306,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E226,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F226,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A226=1,IF(F226=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15221,null,"See CPT",null,241.44299999999998,null,118.116,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E227,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F227,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A227=1,IF(F227=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15240,null,"See CPT",null,1629.885,null,1368.1769999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E228,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F228,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A228=1,IF(F228=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15241,null,"See CPT",null,314.976,null,180.648,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E229,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F229,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A229=1,IF(F229=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15260,null,"See CPT",null,1742.79,null,1448.6579999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E230,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F230,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A230=1,IF(F230=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15261,null,"See CPT",null,369.98099999999999,null,233.916,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E231,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F231,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A231=1,IF(F231=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15271,null,"See CPT",null,275.60399999999998,null,143.59199999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E232,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F232,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A232=1,IF(F232=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15272,null,"See CPT",null,45.161999999999999,null,30.108000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E233,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F233,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A233=1,IF(F233=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15273,null,"See CPT",null,559.89300000000003,null,337.55700000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E234,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F234,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A234=1,IF(F234=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15274,null,"See CPT",null,147.066,null,76.427999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E235,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F235,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A235=1,IF(F235=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15275,null,"See CPT",null,283.13099999999997,null,159.80399999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E236,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F236,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A236=1,IF(F236=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15276,null,"See CPT",null,57.320999999999998,null,43.424999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E237,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F237,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A237=1,IF(F237=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15277,null,"See CPT",null,612.00300000000004,null,383.87700000000001,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E238,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F238,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A238=1,IF(F238=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15278,null,"See CPT",null,170.226,null,95.534999999999997,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E239,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F239,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A239=1,IF(F239=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15570,null,"See CPT",null,1605.567,null,1262.22,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E240,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F240,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A240=1,IF(F240=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15572,null,"See CPT",null,1547.088,null,1272.6420000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E241,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F241,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A241=1,IF(F241=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15574,null,"See CPT",null,1542.4559999999999,null,1269.7469999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E242,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F242,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A242=1,IF(F242=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15576,null,"See CPT",null,1390.1790000000001,null,1129.05,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E243,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F243,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A243=1,IF(F243=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15600,null,"See CPT",null,611.42399999999998,null,369.40199999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E244,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F244,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A244=1,IF(F244=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15610,null,"See CPT",null,659.48099999999999,null,423.24899999999997,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E245,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F245,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A245=1,IF(F245=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15620,null,"See CPT",null,802.49399999999991,null,569.15700000000004,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E246,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F246,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A246=1,IF(F246=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15630,null,"See CPT",null,823.33799999999997,null,595.79099999999994,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E247,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F247,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A247=1,IF(F247=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15650,null,"See CPT",null,900.34500000000003,null,657.16499999999996,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E248,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F248,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A248=1,IF(F248=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15730,null,"See CPT",null,2660.5050000000001,null,1579.5119999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E249,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F249,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A249=1,IF(F249=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15731,null,"See CPT",null,1970.337,null,1728.3150000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E250,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F250,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A250=1,IF(F250=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15733,null,"See CPT",null,1786.7939999999999,null,1786.7939999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E251,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F251,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A251=1,IF(F251=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15734,null,"See CPT",null,2587.5509999999999,null,2587.5509999999999,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E252,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F252,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A252=1,IF(F252=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15736,null,"See CPT",null,2105.8229999999999,null,2105.8229999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E253,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F253,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A253=1,IF(F253=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15738,null,"See CPT",null,2211.201,null,2211.201,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E254,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F254,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A254=1,IF(F254=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15740,null,"See CPT",null,1765.95,null,1445.184,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E255,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F255,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A255=1,IF(F255=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15750,null,"See CPT",null,1611.9359999999999,null,1611.9359999999999,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E256,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F256,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A256=1,IF(F256=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15756,null,"See CPT",null,3955.7279999999996,null,3955.7279999999996,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E257,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F257,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A257=1,IF(F257=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15757,null,"See CPT",null,3945.8850000000002,null,3945.8850000000002,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E258,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F258,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A258=1,IF(F258=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15758,null,"See CPT",null,3944.7269999999999,null,3944.7269999999999,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E259,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F259,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A259=1,IF(F259=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15760,null,"See CPT",null,1492.662,null,1213.0049999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E260,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F260,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A260=1,IF(F260=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15769,null,"See CPT",null,836.65499999999997,null,836.65499999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E261,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F261,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A261=1,IF(F261=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15770,null,"See CPT",null,1170.1590000000001,null,1170.1590000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E262,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F262,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A262=1,IF(F262=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E263,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F263,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A263=1,IF(F263=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15772,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E264,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F264,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A264=1,IF(F264=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A264=1,IF(F264=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E265,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F265,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A265=1,IF(F265=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15774,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E266,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F266,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A266=1,IF(F266=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15775,null,"See CPT",null,666.42899999999997,null,436.56599999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E267,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F267,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A267=1,IF(F267=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15776,null,"See CPT",null,904.39799999999991,null,598.10699999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E268,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F268,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A268=1,IF(F268=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15777,null,"See CPT",null,365.928,null,365.928,null,"000",0,0,0,0,0,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E269,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F269,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A269=1,IF(F269=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15780,null,"See CPT",null,1522.1909999999998,null,1146.9989999999998,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E270,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F270,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A270=1,IF(F270=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15781,null,"See CPT",null,972.72,null,748.06799999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E271,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F271,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A271=1,IF(F271=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15782,null,"See CPT",null,907.29300000000001,null,656.58600000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E272,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F272,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A272=1,IF(F272=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15783,null,"See CPT",null,803.07299999999998,null,610.26599999999996,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E273,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F273,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A273=1,IF(F273=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15786,null,"See CPT",null,429.03899999999999,null,229.28399999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E274,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F274,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A274=1,IF(F274=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15787,null,"See CPT",null,65.426999999999992,null,29.529,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E275,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F275,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A275=1,IF(F275=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E276,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F276,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A276=1,IF(F276=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E277,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F277,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A277=1,IF(F277=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E278,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F278,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A278=1,IF(F278=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E279,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F279,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A279=1,IF(F279=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E280,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F280,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A280=1,IF(F280=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15820,null,"See CPT",null,1010.934,null,892.23900000000003,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E281,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F281,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A281=1,IF(F281=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15821,null,"See CPT",null,1079.8349999999998,null,949.56,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E282,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F282,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A282=1,IF(F282=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15822,null,"See CPT",null,812.91599999999994,null,694.8,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E283,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F283,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A283=1,IF(F283=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15823,null,"See CPT",null,1085.0459999999998,null,953.03399999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E284,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F284,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A284=1,IF(F284=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15824,null,"See CPT",null,1530.5708246400002,null,1530.5708246400002,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E285,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F285,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A285=1,IF(F285=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15825,null,"See CPT",null,1316.0271009600001,null,1316.0271009600001,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E286,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F286,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A286=1,IF(F286=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15826,null,"See CPT",null,1244.4985238400002,null,1244.4985238400002,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E287,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F287,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A287=1,IF(F287=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15828,null,"See CPT",null,4262.7398299200013,null,4262.7398299200013,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E288,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F288,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A288=1,IF(F288=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E289,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F289,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A289=1,IF(F289=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15830,null,"See CPT",null,2018.9729999999997,null,2018.9729999999997,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E290,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F290,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A290=1,IF(F290=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15832,null,"See CPT",null,1584.723,null,1584.723,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E291,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F291,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A291=1,IF(F291=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15833,null,"See CPT",null,1511.19,null,1511.19,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E292,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F292,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A292=1,IF(F292=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15834,null,"See CPT",null,1538.982,null,1538.982,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E293,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F293,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A293=1,IF(F293=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15835,null,"See CPT",null,1604.9879999999998,null,1604.9879999999998,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E294,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F294,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A294=1,IF(F294=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15836,null,"See CPT",null,1307.961,null,1307.961,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E295,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F295,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A295=1,IF(F295=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15837,null,"See CPT",null,1523.9279999999999,null,1240.2180000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E296,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F296,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A296=1,IF(F296=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15838,null,"See CPT",null,1120.365,null,1120.365,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E297,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F297,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A297=1,IF(F297=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15839,null,"See CPT",null,1571.4059999999999,null,1280.748,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E298,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F298,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A298=1,IF(F298=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15840,null,"See CPT",null,1767.1079999999999,null,1767.1079999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E299,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F299,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A299=1,IF(F299=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15841,null,"See CPT",null,3061.752,null,3061.752,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E300,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F300,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A300=1,IF(F300=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15842,null,"See CPT",null,4635.4740000000002,null,4635.4740000000002,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E301,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F301,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A301=1,IF(F301=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15845,null,"See CPT",null,1742.79,null,1742.79,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E302,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F302,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A302=1,IF(F302=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E303,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F303,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A303=1,IF(F303=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15850,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E304,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F304,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A304=1,IF(F304=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15851,null,"See CPT",null,195.702,null,78.165000000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E305,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F305,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A305=1,IF(F305=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15852,null,"See CPT",null,78.744,null,78.744,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E306,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F306,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A306=1,IF(F306=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15860,null,"See CPT",null,181.22699999999998,null,181.22699999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E307,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F307,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A307=1,IF(F307=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15876,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E308,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F308,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A308=1,IF(F308=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15877,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E309,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F309,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A309=1,IF(F309=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15878,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E310,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F310,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A310=1,IF(F310=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15879,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E311,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F311,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A311=1,IF(F311=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15920,null,"See CPT",null,1093.731,null,1093.731,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E312,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F312,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A312=1,IF(F312=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15922,null,"See CPT",null,1376.8620000000001,null,1376.8620000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E313,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F313,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A313=1,IF(F313=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15931,null,"See CPT",null,1220.5319999999999,null,1220.5319999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E314,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F314,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A314=1,IF(F314=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15933,null,"See CPT",null,1503.0840000000001,null,1503.0840000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E315,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F315,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A315=1,IF(F315=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15934,null,"See CPT",null,1638.57,null,1638.57,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E316,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F316,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A316=1,IF(F316=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15935,null,"See CPT",null,1993.4969999999998,null,1993.4969999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E317,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F317,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A317=1,IF(F317=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15936,null,"See CPT",null,1560.9839999999999,null,1560.9839999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E318,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F318,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A318=1,IF(F318=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15937,null,"See CPT",null,1804.7430000000002,null,1804.7430000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E319,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F319,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A319=1,IF(F319=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15940,null,"See CPT",null,1215.8999999999999,null,1215.8999999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E320,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F320,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A320=1,IF(F320=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15941,null,"See CPT",null,1607.883,null,1607.883,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E321,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F321,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A321=1,IF(F321=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15944,null,"See CPT",null,1591.0920000000001,null,1591.0920000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E322,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F322,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A322=1,IF(F322=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15945,null,"See CPT",null,1760.1599999999999,null,1760.1599999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E323,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F323,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A323=1,IF(F323=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15946,null,"See CPT",null,2788.4639999999999,null,2788.4639999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E324,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F324,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A324=1,IF(F324=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15950,null,"See CPT",null,1066.518,null,1066.518,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E325,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F325,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A325=1,IF(F325=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15951,null,"See CPT",null,1555.7729999999999,null,1555.7729999999999,null,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E326,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F326,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A326=1,IF(F326=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15952,null,"See CPT",null,1580.67,null,1580.67,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E327,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F327,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A327=1,IF(F327=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15953,null,"See CPT",null,1741.6319999999998,null,1741.6319999999998,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E328,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F328,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A328=1,IF(F328=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A328=1,IF(F328=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15956,null,"See CPT",null,2017.2360000000001,null,2017.2360000000001,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E329,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F329,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A329=1,IF(F329=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15958,null,"See CPT",null,2051.3969999999999,null,2051.3969999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E330,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F330,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A330=1,IF(F330=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},15999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E331,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F331,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A331=1,IF(F331=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},16000,null,"See CPT",null,132.59100000000001,null,77.007000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E332,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F332,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A332=1,IF(F332=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},16020,null,"See CPT",null,152.85599999999999,null,95.534999999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E333,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F333,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A333=1,IF(F333=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},16025,null,"See CPT",null,277.34100000000001,null,191.07,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E334,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F334,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A334=1,IF(F334=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},16030,null,"See CPT",null,345.084,null,225.23099999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E335,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F335,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A335=1,IF(F335=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},16035,null,"See CPT",null,330.60899999999998,null,330.60899999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E336,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F336,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A336=1,IF(F336=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},16036,null,"See CPT",null,133.749,null,133.749,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E337,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F337,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A337=1,IF(F337=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17000,null,"See CPT",null,117.53699999999999,null,94.376999999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E338,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F338,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A338=1,IF(F338=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17003,null,"See CPT",null,12.158999999999999,null,3.4739999999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E339,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F339,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A339=1,IF(F339=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17004,null,"See CPT",null,292.97399999999999,null,166.75199999999998,null,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E340,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F340,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A340=1,IF(F340=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17106,null,"See CPT",null,601.58100000000002,null,471.88499999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E341,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F341,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A341=1,IF(F341=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17107,null,"See CPT",null,786.28200000000004,null,614.31899999999996,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E342,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F342,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A342=1,IF(F342=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17108,null,"See CPT",null,1104.732,null,896.29200000000003,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E343,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F343,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A343=1,IF(F343=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17110,null,"See CPT",null,203.80799999999999,null,115.8,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E344,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F344,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A344=1,IF(F344=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17111,null,"See CPT",null,237.39,null,140.697,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E345,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F345,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A345=1,IF(F345=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17250,null,"See CPT",null,165.59399999999999,null,64.269000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E346,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F346,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A346=1,IF(F346=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17260,null,"See CPT",null,175.43699999999998,null,121.011,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E347,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F347,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A347=1,IF(F347=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17261,null,"See CPT",null,262.28700000000003,null,147.64499999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E348,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F348,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A348=1,IF(F348=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17262,null,"See CPT",null,314.976,null,187.017,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E349,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F349,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A349=1,IF(F349=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17263,null,"See CPT",null,341.03099999999995,null,207.86099999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E350,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F350,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A350=1,IF(F350=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17264,null,"See CPT",null,365.34899999999999,null,222.91499999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E351,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F351,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A351=1,IF(F351=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17266,null,"See CPT",null,415.14299999999997,null,261.12899999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E352,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F352,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A352=1,IF(F352=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17270,null,"See CPT",null,264.02399999999994,null,161.541,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E353,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F353,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A353=1,IF(F353=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17271,null,"See CPT",null,292.97399999999999,null,178.33199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E354,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F354,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A354=1,IF(F354=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17272,null,"See CPT",null,332.92500000000001,null,206.124,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E355,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F355,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A355=1,IF(F355=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17273,null,"See CPT",null,368.82299999999998,null,233.33700000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E356,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F356,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A356=1,IF(F356=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17274,null,"See CPT",null,430.19699999999995,null,284.28899999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E357,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F357,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A357=1,IF(F357=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17276,null,"See CPT",null,497.93999999999994,null,341.61,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E358,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F358,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A358=1,IF(F358=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17280,null,"See CPT",null,248.96999999999997,null,147.64499999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E359,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F359,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A359=1,IF(F359=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17281,null,"See CPT",null,316.71299999999997,null,201.49199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E360,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F360,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A360=1,IF(F360=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17282,null,"See CPT",null,362.45399999999995,null,232.75799999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E361,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F361,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A361=1,IF(F361=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17283,null,"See CPT",null,427.88099999999997,null,290.07900000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E362,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F362,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A362=1,IF(F362=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17284,null,"See CPT",null,486.36,null,338.13599999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E363,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F363,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A363=1,IF(F363=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17286,null,"See CPT",null,623.00400000000002,null,459.726,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E364,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F364,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A364=1,IF(F364=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17311,null,"See CPT",null,1192.1610000000001,null,603.31799999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E365,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F365,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A365=1,IF(F365=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17312,null,"See CPT",null,727.22400000000005,null,320.76600000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E366,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F366,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A366=1,IF(F366=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17313,null,"See CPT",null,1120.944,null,541.36500000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E367,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F367,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A367=1,IF(F367=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17314,null,"See CPT",null,696.53699999999992,null,298.185,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E368,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F368,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A368=1,IF(F368=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17315,null,"See CPT",null,134.32799999999997,null,84.533999999999992,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E369,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F369,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A369=1,IF(F369=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E370,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F370,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A370=1,IF(F370=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E371,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F371,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A371=1,IF(F371=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17380,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E372,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F372,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A372=1,IF(F372=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},17999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E373,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F373,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A373=1,IF(F373=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19000,null,"See CPT",null,192.80699999999999,null,72.953999999999994,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E374,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F374,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A374=1,IF(F374=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19001,null,"See CPT",null,46.32,null,35.897999999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E375,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F375,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A375=1,IF(F375=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19020,null,"See CPT",null,863.86799999999994,null,545.41800000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E376,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F376,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A376=1,IF(F376=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19030,null,"See CPT",null,301.65899999999999,null,127.95899999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E377,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F377,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A377=1,IF(F377=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19081,null,"See CPT",null,1037.568,null,279.65699999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E378,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F378,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A378=1,IF(F378=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19082,null,"See CPT",null,836.65499999999997,null,140.11799999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E379,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F379,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A379=1,IF(F379=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19083,null,"See CPT",null,1039.884,null,264.60300000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E380,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F380,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A380=1,IF(F380=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19084,null,"See CPT",null,822.18,null,130.85399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E381,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F381,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A381=1,IF(F381=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19085,null,"See CPT",null,1604.4090000000001,null,305.71199999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E382,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F382,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A382=1,IF(F382=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19086,null,"See CPT",null,1278.4319999999998,null,152.27699999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E383,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F383,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A383=1,IF(F383=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19100,null,"See CPT",null,282.55199999999996,null,118.116,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E384,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F384,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A384=1,IF(F384=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19101,null,"See CPT",null,609.6869999999999,null,386.77199999999999,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E385,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F385,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A385=1,IF(F385=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19105,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E386,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F386,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A386=1,IF(F386=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19110,null,"See CPT",null,893.976,null,613.74,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E387,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F387,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A387=1,IF(F387=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19112,null,"See CPT",null,847.077,null,562.20900000000006,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E388,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F388,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A388=1,IF(F388=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19120,null,"See CPT",null,910.18799999999999,null,722.01300000000003,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E389,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F389,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A389=1,IF(F389=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19125,null,"See CPT",null,1003.986,null,799.59900000000005,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E390,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F390,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A390=1,IF(F390=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19126,null,"See CPT",null,272.709,null,272.709,null,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E391,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F391,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A391=1,IF(F391=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19281,null,"See CPT",null,441.77699999999999,null,167.91,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E392,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F392,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A392=1,IF(F392=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A392=1,IF(F392=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19282,null,"See CPT",null,317.87099999999998,null,83.954999999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E393,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F393,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A393=1,IF(F393=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19283,null,"See CPT",null,488.67599999999993,null,169.64699999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E394,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F394,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A394=1,IF(F394=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19284,null,"See CPT",null,375.19200000000001,null,85.691999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E395,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F395,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A395=1,IF(F395=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19285,null,"See CPT",null,785.12400000000002,null,144.17100000000002,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E396,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F396,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A396=1,IF(F396=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19286,null,"See CPT",null,666.42899999999997,null,71.795999999999992,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E397,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F397,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A397=1,IF(F397=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19287,null,"See CPT",null,1350.2280000000001,null,214.809,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E398,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F398,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A398=1,IF(F398=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19288,null,"See CPT",null,1072.308,null,107.694,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E399,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F399,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A399=1,IF(F399=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19294,null,"See CPT",null,279.65699999999998,null,279.65699999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E400,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F400,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A400=1,IF(F400=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19296,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E401,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F401,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A401=1,IF(F401=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19297,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E402,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F402,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A402=1,IF(F402=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19298,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E403,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F403,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A403=1,IF(F403=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E404,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F404,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A404=1,IF(F404=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E405,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F405,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A405=1,IF(F405=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E406,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F406,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A406=1,IF(F406=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E407,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F407,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A407=1,IF(F407=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E408,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F408,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A408=1,IF(F408=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E409,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F409,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A409=1,IF(F409=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E410,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F410,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A410=1,IF(F410=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19316,null,"See CPT",null,1367.598,null,1367.598,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E411,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F411,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A411=1,IF(F411=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19318,null,"See CPT",null,1885.2240000000002,null,1885.2240000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E412,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F412,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A412=1,IF(F412=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19325,null,"See CPT",null,1063.0439999999999,null,1063.0439999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E413,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F413,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A413=1,IF(F413=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19328,null,"See CPT",null,959.40300000000002,null,959.40300000000002,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E414,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F414,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A414=1,IF(F414=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19330,null,"See CPT",null,1115.7329999999999,null,1115.7329999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E415,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F415,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A415=1,IF(F415=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19340,null,"See CPT",null,1309.6980000000001,null,1309.6980000000001,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E416,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F416,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A416=1,IF(F416=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19342,null,"See CPT",null,1315.4879999999998,null,1315.4879999999998,null,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E417,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F417,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A417=1,IF(F417=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19350,null,"See CPT",null,1461.9749999999999,null,1162.6319999999998,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E418,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F418,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A418=1,IF(F418=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E419,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F419,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A419=1,IF(F419=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19357,null,"See CPT",null,2023.0259999999998,null,2023.0259999999998,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E420,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F420,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A420=1,IF(F420=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19361,null,"See CPT",null,2683.0860000000002,null,2683.0860000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E421,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F421,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A421=1,IF(F421=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19364,null,"See CPT",null,4681.7939999999999,null,4681.7939999999999,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E422,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F422,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A422=1,IF(F422=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19367,null,"See CPT",null,3045.54,null,3045.54,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E423,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F423,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A423=1,IF(F423=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19368,null,"See CPT",null,3734.5499999999997,null,3734.5499999999997,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E424,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F424,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A424=1,IF(F424=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19369,null,"See CPT",null,3469.9470000000001,null,3469.9470000000001,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E425,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F425,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A425=1,IF(F425=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19370,null,"See CPT",null,1159.1579999999999,null,1159.1579999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E426,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F426,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A426=1,IF(F426=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19371,null,"See CPT",null,1230.954,null,1230.954,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E427,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F427,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A427=1,IF(F427=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19380,null,"See CPT",null,1394.8109999999999,null,1394.8109999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E428,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F428,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A428=1,IF(F428=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19396,null,"See CPT",null,514.73099999999999,null,244.91700000000003,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E429,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F429,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A429=1,IF(F429=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},19499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E430,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F430,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A430=1,IF(F430=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20100,null,"See CPT",null,1035.8309999999999,null,1035.8309999999999,null,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E431,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F431,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A431=1,IF(F431=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20101,null,"See CPT",null,1099.521,null,363.03299999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E432,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F432,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A432=1,IF(F432=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20102,null,"See CPT",null,1138.3140000000001,null,439.46099999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E433,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F433,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A433=1,IF(F433=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20103,null,"See CPT",null,1032.357,null,594.63299999999992,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E434,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F434,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A434=1,IF(F434=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20150,null,"See CPT",null,1734.105,null,1734.105,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E435,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F435,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A435=1,IF(F435=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20200,null,"See CPT",null,407.03699999999998,null,161.541,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E436,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F436,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A436=1,IF(F436=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20205,null,"See CPT",null,559.31399999999996,null,264.60300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E437,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F437,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A437=1,IF(F437=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20206,null,"See CPT",null,440.61900000000003,null,97.850999999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E438,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F438,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A438=1,IF(F438=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20220,null,"See CPT",null,452.19899999999996,null,148.22399999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E439,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F439,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A439=1,IF(F439=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20225,null,"See CPT",null,748.06799999999998,null,221.178,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E440,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F440,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A440=1,IF(F440=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20240,null,"See CPT",null,243.75899999999999,null,243.75899999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E441,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F441,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A441=1,IF(F441=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20245,null,"See CPT",null,592.89599999999996,null,592.89599999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E442,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F442,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A442=1,IF(F442=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20250,null,"See CPT",null,677.43,null,677.43,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E443,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F443,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A443=1,IF(F443=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20251,null,"See CPT",null,739.96199999999999,null,739.96199999999999,null,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E444,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F444,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A444=1,IF(F444=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20500,null,"See CPT",null,210.17699999999999,null,151.69800000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E445,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F445,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A445=1,IF(F445=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20501,null,"See CPT",null,265.18200000000002,null,63.690000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E446,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F446,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A446=1,IF(F446=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20520,null,"See CPT",null,391.404,null,259.392,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E447,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F447,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A447=1,IF(F447=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20525,null,"See CPT",null,864.447,null,426.72300000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E448,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F448,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A448=1,IF(F448=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20526,null,"See CPT",null,141.27599999999998,null,97.850999999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E449,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F449,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A449=1,IF(F449=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20527,null,"See CPT",null,151.119,null,111.747,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E450,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F450,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A450=1,IF(F450=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20550,null,"See CPT",null,97.850999999999999,null,66.005999999999986,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E451,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F451,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A451=1,IF(F451=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20551,null,"See CPT",null,100.167,null,67.163999999999987,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E452,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F452,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A452=1,IF(F452=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20552,null,"See CPT",null,93.798000000000002,null,64.269000000000005,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E453,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F453,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A453=1,IF(F453=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20553,null,"See CPT",null,108.85199999999999,null,73.533000000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E454,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F454,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A454=1,IF(F454=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20555,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E455,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F455,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A455=1,IF(F455=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20560,null,"See CPT",null,45.741,null,27.212999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E456,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F456,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A456=1,IF(F456=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A456=1,IF(F456=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20561,null,"See CPT",null,67.163999999999987,null,41.687999999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E457,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F457,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A457=1,IF(F457=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20600,null,"See CPT",null,90.323999999999998,null,60.216000000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E458,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F458,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A458=1,IF(F458=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20604,null,"See CPT",null,143.01300000000001,null,78.744,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E459,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F459,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A459=1,IF(F459=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20605,null,"See CPT",null,94.376999999999995,null,63.111000000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E460,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F460,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A460=1,IF(F460=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20606,null,"See CPT",null,156.33000000000001,null,89.745000000000005,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E461,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F461,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A461=1,IF(F461=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20610,null,"See CPT",null,111.747,null,77.585999999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E462,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F462,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A462=1,IF(F462=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20611,null,"See CPT",null,174.279,null,101.904,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E463,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F463,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A463=1,IF(F463=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20612,null,"See CPT",null,111.16799999999999,null,70.637999999999991,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E464,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F464,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A464=1,IF(F464=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20615,null,"See CPT",null,459.726,null,281.39400000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E465,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F465,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A465=1,IF(F465=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20650,null,"See CPT",null,387.351,null,274.44600000000003,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E466,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F466,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A466=1,IF(F466=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20660,null,"See CPT",null,410.51099999999997,null,410.51099999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E467,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F467,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A467=1,IF(F467=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20661,null,"See CPT",null,891.66,null,891.66,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E468,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F468,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A468=1,IF(F468=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20662,null,"See CPT",null,904.97699999999998,null,904.97699999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E469,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F469,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A469=1,IF(F469=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20663,null,"See CPT",null,833.76,null,833.76,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E470,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F470,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A470=1,IF(F470=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20664,null,"See CPT",null,1526.2439999999999,null,1526.2439999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E471,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F471,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A471=1,IF(F471=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20665,null,"See CPT",null,200.91300000000001,null,163.857,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E472,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F472,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A472=1,IF(F472=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20670,null,"See CPT",null,689.01,null,253.023,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E473,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F473,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A473=1,IF(F473=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20680,null,"See CPT",null,1091.9939999999999,null,727.22400000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E474,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F474,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A474=1,IF(F474=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20690,null,"See CPT",null,1031.1989999999998,null,1031.1989999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E475,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F475,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A475=1,IF(F475=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20692,null,"See CPT",null,1937.3340000000001,null,1937.3340000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E476,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F476,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A476=1,IF(F476=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20693,null,"See CPT",null,772.38599999999997,null,772.38599999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E477,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F477,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A477=1,IF(F477=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20694,null,"See CPT",null,764.28,null,591.73800000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E478,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F478,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A478=1,IF(F478=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20696,null,"See CPT",null,2058.924,null,2058.924,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E479,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F479,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A479=1,IF(F479=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20697,null,"See CPT",null,3818.5050000000001,null,3818.5050000000001,null,"000",0,0,0,3,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E480,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F480,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A480=1,IF(F480=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20700,null,"See CPT",null,142.434,null,142.434,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E481,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F481,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A481=1,IF(F481=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20701,null,"See CPT",null,107.11500000000001,null,107.11500000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E482,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F482,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A482=1,IF(F482=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20702,null,"See CPT",null,237.39,null,237.39,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E483,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F483,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A483=1,IF(F483=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20703,null,"See CPT",null,170.80500000000001,null,170.80500000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E484,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F484,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A484=1,IF(F484=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20704,null,"See CPT",null,248.39099999999999,null,248.39099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E485,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F485,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A485=1,IF(F485=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20705,null,"See CPT",null,204.38699999999997,null,204.38699999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E486,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F486,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A486=1,IF(F486=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20802,null,"See CPT",null,4715.9549999999999,null,4715.9549999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F487,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A487=1,IF(F487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20805,null,"See CPT",null,5600.6670000000004,null,5600.6670000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E488,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F488,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A488=1,IF(F488=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20808,null,"See CPT",null,6754.6139999999996,null,6754.6139999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E489,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F489,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A489=1,IF(F489=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20816,null,"See CPT",null,3530.163,null,3530.163,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E490,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F490,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A490=1,IF(F490=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20822,null,"See CPT",null,3051.9090000000001,null,3051.9090000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E491,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F491,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A491=1,IF(F491=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20824,null,"See CPT",null,3537.1110000000003,null,3537.1110000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E492,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F492,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A492=1,IF(F492=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20827,null,"See CPT",null,3133.5479999999998,null,3133.5479999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E493,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F493,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A493=1,IF(F493=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20838,null,"See CPT",null,4790.6459999999997,null,4790.6459999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E494,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F494,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A494=1,IF(F494=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20900,null,"See CPT",null,735.32999999999993,null,313.81799999999998,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E495,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F495,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A495=1,IF(F495=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20902,null,"See CPT",null,476.517,null,476.517,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E496,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F496,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A496=1,IF(F496=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20910,null,"See CPT",null,829.12800000000004,null,829.12800000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E497,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F497,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A497=1,IF(F497=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20912,null,"See CPT",null,845.91899999999998,null,845.91899999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E498,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F498,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A498=1,IF(F498=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20920,null,"See CPT",null,702.327,null,702.327,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E499,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F499,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A499=1,IF(F499=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20922,null,"See CPT",null,1074.0450000000001,null,851.70900000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E500,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F500,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A500=1,IF(F500=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20924,null,"See CPT",null,881.23800000000006,null,881.23800000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E501,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F501,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A501=1,IF(F501=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20930,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E502,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F502,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A502=1,IF(F502=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20931,null,"See CPT",null,187.596,null,187.596,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E503,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F503,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A503=1,IF(F503=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20932,null,"See CPT",null,1290.5909999999999,null,1290.5909999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E504,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F504,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A504=1,IF(F504=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20933,null,"See CPT",null,1184.0549999999998,null,1184.0549999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E505,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F505,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A505=1,IF(F505=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20934,null,"See CPT",null,1289.433,null,1289.433,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E506,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F506,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A506=1,IF(F506=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20936,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E507,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F507,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A507=1,IF(F507=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20937,null,"See CPT",null,283.13099999999997,null,283.13099999999997,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E508,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F508,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A508=1,IF(F508=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20938,null,"See CPT",null,311.50200000000001,null,311.50200000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E509,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F509,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A509=1,IF(F509=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20939,null,"See CPT",null,117.53699999999999,null,117.53699999999999,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E510,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F510,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A510=1,IF(F510=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20950,null,"See CPT",null,496.20300000000003,null,152.27699999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E511,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F511,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A511=1,IF(F511=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20955,null,"See CPT",null,4253.3339999999998,null,4253.3339999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E512,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F512,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A512=1,IF(F512=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20956,null,"See CPT",null,4535.8860000000004,null,4535.8860000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E513,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F513,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A513=1,IF(F513=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20957,null,"See CPT",null,4724.6399999999994,null,4724.6399999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E514,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F514,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A514=1,IF(F514=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20962,null,"See CPT",null,4586.8379999999997,null,4586.8379999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E515,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F515,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A515=1,IF(F515=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20969,null,"See CPT",null,4707.2699999999995,null,4707.2699999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E516,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F516,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A516=1,IF(F516=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20970,null,"See CPT",null,4891.9709999999995,null,4891.9709999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E517,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F517,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A517=1,IF(F517=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20972,null,"See CPT",null,4878.6540000000005,null,4878.6540000000005,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E518,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F518,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A518=1,IF(F518=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20973,null,"See CPT",null,5150.7839999999997,null,5150.7839999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E519,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F519,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A519=1,IF(F519=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20974,null,"See CPT",null,143.01300000000001,null,86.271000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E520,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F520,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A520=1,IF(F520=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A520=1,IF(F520=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20975,null,"See CPT",null,302.81700000000001,null,302.81700000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E521,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F521,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A521=1,IF(F521=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20979,null,"See CPT",null,95.534999999999997,null,53.847000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E522,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F522,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A522=1,IF(F522=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20982,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E523,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F523,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A523=1,IF(F523=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20983,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E524,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F524,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A524=1,IF(F524=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20985,null,"See CPT",null,248.39099999999999,null,248.39099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E525,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F525,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A525=1,IF(F525=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},20999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E526,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F526,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A526=1,IF(F526=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21010,null,"See CPT",null,1285.9590000000001,null,1285.9590000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E527,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F527,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A527=1,IF(F527=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21011,null,"See CPT",null,667.58699999999999,null,451.041,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E528,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F528,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A528=1,IF(F528=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21012,null,"See CPT",null,590.57999999999993,null,590.57999999999993,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E529,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F529,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A529=1,IF(F529=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21013,null,"See CPT",null,957.66599999999994,null,698.85299999999995,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E530,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F530,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A530=1,IF(F530=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21014,null,"See CPT",null,909.60900000000004,null,909.60900000000004,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E531,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F531,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A531=1,IF(F531=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21015,null,"See CPT",null,1220.5319999999999,null,1220.5319999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E532,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F532,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A532=1,IF(F532=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E533,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F533,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A533=1,IF(F533=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21025,null,"See CPT",null,1406.97,null,1157.4209999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E534,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F534,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A534=1,IF(F534=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21026,null,"See CPT",null,969.24599999999987,null,759.64799999999991,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E535,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F535,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A535=1,IF(F535=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21029,null,"See CPT",null,1364.1239999999998,null,1080.9930000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E536,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F536,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A536=1,IF(F536=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21030,null,"See CPT",null,846.49799999999993,null,647.322,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E537,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F537,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A537=1,IF(F537=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21031,null,"See CPT",null,696.53699999999992,null,479.99099999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E538,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F538,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A538=1,IF(F538=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21032,null,"See CPT",null,693.06299999999999,null,468.411,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E539,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F539,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A539=1,IF(F539=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21034,null,"See CPT",null,2325.2639999999997,null,1989.444,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E540,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F540,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A540=1,IF(F540=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21040,null,"See CPT",null,859.23599999999999,null,652.53300000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E541,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F541,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A541=1,IF(F541=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21044,null,"See CPT",null,1518.1379999999999,null,1518.1379999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E542,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F542,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A542=1,IF(F542=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21045,null,"See CPT",null,2100.6120000000001,null,2100.6120000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E543,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F543,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A543=1,IF(F543=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21046,null,"See CPT",null,1771.1610000000001,null,1771.1610000000001,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E544,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F544,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A544=1,IF(F544=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21047,null,"See CPT",null,2193.252,null,2193.252,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E545,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F545,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A545=1,IF(F545=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21048,null,"See CPT",null,1792.5840000000001,null,1792.5840000000001,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E546,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F546,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A546=1,IF(F546=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21049,null,"See CPT",null,2134.7729999999997,null,2134.7729999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E547,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F547,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A547=1,IF(F547=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21050,null,"See CPT",null,1519.875,null,1519.875,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E548,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F548,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A548=1,IF(F548=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21060,null,"See CPT",null,1375.125,null,1375.125,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E549,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F549,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A549=1,IF(F549=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21070,null,"See CPT",null,1085.0459999999998,null,1085.0459999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E550,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F550,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A550=1,IF(F550=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21073,null,"See CPT",null,674.53499999999997,null,431.35500000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E551,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F551,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A551=1,IF(F551=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21076,null,"See CPT",null,1508.8739999999998,null,1225.164,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E552,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F552,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A552=1,IF(F552=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21077,null,"See CPT",null,3683.0189999999998,null,3002.1149999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E553,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F553,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A553=1,IF(F553=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21079,null,"See CPT",null,2521.5449999999996,null,2021.2889999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E554,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F554,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A554=1,IF(F554=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21080,null,"See CPT",null,2917.5810000000001,null,2302.683,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E555,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F555,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A555=1,IF(F555=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21081,null,"See CPT",null,2689.4549999999999,null,2108.7179999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E556,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F556,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A556=1,IF(F556=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21082,null,"See CPT",null,2460.75,null,1917.069,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E557,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F557,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A557=1,IF(F557=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21083,null,"See CPT",null,2351.8979999999997,null,1779.8459999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E558,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F558,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A558=1,IF(F558=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21084,null,"See CPT",null,2685.402,null,2058.3449999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E559,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F559,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A559=1,IF(F559=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21085,null,"See CPT",null,1185.213,null,834.91800000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E560,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F560,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A560=1,IF(F560=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21086,null,"See CPT",null,2745.6179999999999,null,2212.9380000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E561,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F561,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A561=1,IF(F561=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21087,null,"See CPT",null,2745.6179999999999,null,2212.9380000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E562,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F562,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A562=1,IF(F562=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E563,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F563,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A563=1,IF(F563=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21089,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,1,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E564,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F564,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A564=1,IF(F564=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21100,null,"See CPT",null,1158.579,null,621.846,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E565,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F565,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A565=1,IF(F565=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21110,null,"See CPT",null,1568.511,null,1294.0650000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E566,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F566,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A566=1,IF(F566=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21116,null,"See CPT",null,394.29899999999998,null,77.007000000000005,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E567,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F567,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A567=1,IF(F567=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21120,null,"See CPT",null,1224.5849999999998,null,926.97900000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E568,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F568,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A568=1,IF(F568=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21121,null,"See CPT",null,1155.684,null,954.19200000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E569,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F569,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A569=1,IF(F569=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21122,null,"See CPT",null,1349.07,null,1349.07,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E570,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F570,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A570=1,IF(F570=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21123,null,"See CPT",null,1525.665,null,1525.665,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E571,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F571,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A571=1,IF(F571=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21125,null,"See CPT",null,5147.3100000000004,null,1169.58,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E572,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F572,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A572=1,IF(F572=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21127,null,"See CPT",null,7657.8539999999994,null,1340.385,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E573,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F573,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A573=1,IF(F573=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21137,null,"See CPT",null,1300.434,null,1300.434,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E574,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F574,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A574=1,IF(F574=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21138,null,"See CPT",null,1580.67,null,1580.67,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E575,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F575,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A575=1,IF(F575=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21139,null,"See CPT",null,1915.3319999999999,null,1915.3319999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E576,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F576,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A576=1,IF(F576=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21141,null,"See CPT",null,2311.9470000000001,null,2311.9470000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E577,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F577,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A577=1,IF(F577=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21142,null,"See CPT",null,2371.5839999999998,null,2371.5839999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E578,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F578,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A578=1,IF(F578=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21143,null,"See CPT",null,2455.5389999999998,null,2455.5389999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E579,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F579,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A579=1,IF(F579=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21145,null,"See CPT",null,2682.5070000000001,null,2682.5070000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E580,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F580,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A580=1,IF(F580=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21146,null,"See CPT",null,2801.7809999999999,null,2801.7809999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E581,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F581,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A581=1,IF(F581=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21147,null,"See CPT",null,2948.268,null,2948.268,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E582,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F582,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A582=1,IF(F582=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21150,null,"See CPT",null,2914.107,null,2914.107,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E583,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F583,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A583=1,IF(F583=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21151,null,"See CPT",null,3201.2909999999997,null,3201.2909999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E584,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F584,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A584=1,IF(F584=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A584=1,IF(F584=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21154,null,"See CPT",null,3441.5759999999996,null,3441.5759999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E585,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F585,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A585=1,IF(F585=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21155,null,"See CPT",null,3810.3989999999999,null,3810.3989999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E586,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F586,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A586=1,IF(F586=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21159,null,"See CPT",null,4553.2560000000003,null,4553.2560000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E587,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F587,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A587=1,IF(F587=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21160,null,"See CPT",null,4933.6589999999997,null,4933.6589999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E588,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F588,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A588=1,IF(F588=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21172,null,"See CPT",null,3628.0139999999997,null,3628.0139999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E589,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F589,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A589=1,IF(F589=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21175,null,"See CPT",null,3808.6619999999998,null,3808.6619999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E590,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F590,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A590=1,IF(F590=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21179,null,"See CPT",null,2621.1330000000003,null,2621.1330000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E591,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F591,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A591=1,IF(F591=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21180,null,"See CPT",null,2926.2660000000001,null,2926.2660000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E592,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F592,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A592=1,IF(F592=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21181,null,"See CPT",null,1281.327,null,1281.327,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E593,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F593,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A593=1,IF(F593=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21182,null,"See CPT",null,3637.2779999999998,null,3637.2779999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E594,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F594,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A594=1,IF(F594=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21183,null,"See CPT",null,3956.3069999999998,null,3956.3069999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E595,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F595,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A595=1,IF(F595=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21184,null,"See CPT",null,4253.3339999999998,null,4253.3339999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E596,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F596,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A596=1,IF(F596=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21188,null,"See CPT",null,2790.78,null,2790.78,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E597,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F597,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A597=1,IF(F597=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21193,null,"See CPT",null,2133.6150000000002,null,2133.6150000000002,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E598,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F598,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A598=1,IF(F598=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21194,null,"See CPT",null,2466.54,null,2466.54,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E599,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F599,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A599=1,IF(F599=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21195,null,"See CPT",null,2377.3740000000003,null,2377.3740000000003,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E600,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F600,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A600=1,IF(F600=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21196,null,"See CPT",null,2446.8539999999998,null,2446.8539999999998,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E601,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F601,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A601=1,IF(F601=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21198,null,"See CPT",null,1874.2229999999997,null,1874.2229999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E602,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F602,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A602=1,IF(F602=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21199,null,"See CPT",null,1759.5809999999999,null,1759.5809999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E603,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F603,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A603=1,IF(F603=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21206,null,"See CPT",null,1730.0519999999999,null,1730.0519999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E604,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F604,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A604=1,IF(F604=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21208,null,"See CPT",null,3091.8599999999997,null,1291.17,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E605,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F605,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A605=1,IF(F605=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21209,null,"See CPT",null,1422.6030000000001,null,1061.3069999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E606,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F606,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A606=1,IF(F606=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21210,null,"See CPT",null,3449.6819999999998,null,1328.8049999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E607,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F607,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A607=1,IF(F607=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21215,null,"See CPT",null,7795.655999999999,null,1377.4409999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E608,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F608,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A608=1,IF(F608=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21230,null,"See CPT",null,1308.54,null,1308.54,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E609,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F609,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A609=1,IF(F609=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21235,null,"See CPT",null,1308.54,null,990.66899999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E610,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F610,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A610=1,IF(F610=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21240,null,"See CPT",null,1824.4290000000001,null,1824.4290000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E611,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F611,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A611=1,IF(F611=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21242,null,"See CPT",null,1754.9489999999998,null,1754.9489999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E612,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F612,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A612=1,IF(F612=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21243,null,"See CPT",null,2785.569,null,2785.569,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E613,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F613,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A613=1,IF(F613=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21244,null,"See CPT",null,1797.2159999999999,null,1797.2159999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E614,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F614,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A614=1,IF(F614=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21245,null,"See CPT",null,2212.3589999999999,null,1668.0989999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E615,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F615,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A615=1,IF(F615=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21246,null,"See CPT",null,1471.818,null,1471.818,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E616,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F616,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A616=1,IF(F616=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21247,null,"See CPT",null,2736.3539999999998,null,2736.3539999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E617,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F617,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A617=1,IF(F617=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21248,null,"See CPT",null,1770.0029999999999,null,1392.4950000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E618,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F618,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A618=1,IF(F618=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21249,null,"See CPT",null,2389.5329999999999,null,1947.7560000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E619,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F619,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A619=1,IF(F619=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21255,null,"See CPT",null,2371.0050000000001,null,2371.0050000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E620,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F620,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A620=1,IF(F620=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21256,null,"See CPT",null,2138.826,null,2138.826,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E621,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F621,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A621=1,IF(F621=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E622,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F622,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A622=1,IF(F622=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E623,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F623,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A623=1,IF(F623=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E624,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F624,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A624=1,IF(F624=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E625,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F625,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A625=1,IF(F625=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E626,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F626,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A626=1,IF(F626=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21270,null,"See CPT",null,1785.636,null,1291.17,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E627,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F627,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A627=1,IF(F627=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21275,null,"See CPT",null,1460.817,null,1460.817,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E628,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F628,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A628=1,IF(F628=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21280,null,"See CPT",null,1009.197,null,1009.197,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E629,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F629,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A629=1,IF(F629=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21282,null,"See CPT",null,687.85199999999998,null,687.85199999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E630,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F630,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A630=1,IF(F630=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E631,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F631,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A631=1,IF(F631=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E632,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F632,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A632=1,IF(F632=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21299,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E633,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F633,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A633=1,IF(F633=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21310,null,"See CPT",null,243.18,null,46.32,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E634,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F634,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A634=1,IF(F634=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21315,null,"See CPT",null,530.36400000000003,null,275.02499999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E635,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F635,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A635=1,IF(F635=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21320,null,"See CPT",null,485.20200000000006,null,237.39,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E636,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F636,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A636=1,IF(F636=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21325,null,"See CPT",null,822.18,null,822.18,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E637,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F637,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A637=1,IF(F637=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21330,null,"See CPT",null,979.08899999999994,null,979.08899999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E638,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F638,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A638=1,IF(F638=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21335,null,"See CPT",null,1294.0650000000001,null,1294.0650000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E639,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F639,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A639=1,IF(F639=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21336,null,"See CPT",null,1176.528,null,1176.528,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E640,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F640,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A640=1,IF(F640=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21337,null,"See CPT",null,763.70099999999991,null,528.04799999999989,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E641,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F641,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A641=1,IF(F641=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21338,null,"See CPT",null,1230.954,null,1230.954,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E642,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F642,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A642=1,IF(F642=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21339,null,"See CPT",null,1384.3889999999999,null,1384.3889999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E643,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F643,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A643=1,IF(F643=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21340,null,"See CPT",null,1318.383,null,1318.383,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E644,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F644,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A644=1,IF(F644=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21343,null,"See CPT",null,1950.0719999999999,null,1950.0719999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E645,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F645,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A645=1,IF(F645=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21344,null,"See CPT",null,2463.0659999999998,null,2463.0659999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E646,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F646,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A646=1,IF(F646=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21345,null,"See CPT",null,1438.8150000000001,null,1121.5230000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E647,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F647,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A647=1,IF(F647=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21346,null,"See CPT",null,1845.2729999999999,null,1845.2729999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E648,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F648,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A648=1,IF(F648=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A648=1,IF(F648=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21347,null,"See CPT",null,1858.0110000000002,null,1858.0110000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E649,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F649,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A649=1,IF(F649=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21348,null,"See CPT",null,1911.8580000000002,null,1911.8580000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E650,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F650,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A650=1,IF(F650=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21355,null,"See CPT",null,809.44200000000001,null,578.42100000000005,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E651,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F651,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A651=1,IF(F651=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21356,null,"See CPT",null,912.50400000000002,null,664.11300000000006,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E652,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F652,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A652=1,IF(F652=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21360,null,"See CPT",null,920.61,null,920.61,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E653,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F653,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A653=1,IF(F653=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21365,null,"See CPT",null,1887.54,null,1887.54,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E654,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F654,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A654=1,IF(F654=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21366,null,"See CPT",null,2200.779,null,2200.779,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E655,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F655,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A655=1,IF(F655=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21385,null,"See CPT",null,1295.223,null,1295.223,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E656,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F656,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A656=1,IF(F656=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21386,null,"See CPT",null,1197.3719999999998,null,1197.3719999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E657,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F657,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A657=1,IF(F657=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21387,null,"See CPT",null,1350.8069999999998,null,1350.8069999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E658,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F658,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A658=1,IF(F658=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21390,null,"See CPT",null,1393.653,null,1393.653,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E659,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F659,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A659=1,IF(F659=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21395,null,"See CPT",null,1744.5269999999998,null,1744.5269999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E660,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F660,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A660=1,IF(F660=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21400,null,"See CPT",null,373.45499999999998,null,289.5,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E661,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F661,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A661=1,IF(F661=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21401,null,"See CPT",null,929.29500000000007,null,567.99900000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E662,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F662,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A662=1,IF(F662=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21406,null,"See CPT",null,1013.8290000000001,null,1013.8290000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E663,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F663,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A663=1,IF(F663=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21407,null,"See CPT",null,1115.7329999999999,null,1115.7329999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E664,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F664,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A664=1,IF(F664=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21408,null,"See CPT",null,1560.405,null,1560.405,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E665,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F665,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A665=1,IF(F665=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21421,null,"See CPT",null,1193.319,null,995.30100000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E666,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F666,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A666=1,IF(F666=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21422,null,"See CPT",null,1124.4180000000001,null,1124.4180000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E667,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F667,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A667=1,IF(F667=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21423,null,"See CPT",null,1405.8120000000001,null,1405.8120000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E668,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F668,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A668=1,IF(F668=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21431,null,"See CPT",null,1243.692,null,1243.692,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E669,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F669,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A669=1,IF(F669=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21432,null,"See CPT",null,1264.5360000000001,null,1264.5360000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E670,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F670,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A670=1,IF(F670=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21433,null,"See CPT",null,2983.0080000000003,null,2983.0080000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E671,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F671,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A671=1,IF(F671=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21435,null,"See CPT",null,2424.2729999999997,null,2424.2729999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E672,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F672,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A672=1,IF(F672=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21436,null,"See CPT",null,3502.95,null,3502.95,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E673,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F673,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A673=1,IF(F673=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21440,null,"See CPT",null,1226.9010000000001,null,979.08899999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E674,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F674,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A674=1,IF(F674=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21445,null,"See CPT",null,1438.2359999999999,null,1148.1569999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E675,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F675,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A675=1,IF(F675=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21450,null,"See CPT",null,1087.941,null,875.44799999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E676,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F676,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A676=1,IF(F676=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21451,null,"See CPT",null,1406.3909999999998,null,1165.5269999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E677,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F677,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A677=1,IF(F677=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21452,null,"See CPT",null,1404.654,null,844.18200000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E678,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F678,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A678=1,IF(F678=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21453,null,"See CPT",null,1987.1279999999999,null,1681.9949999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E679,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F679,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A679=1,IF(F679=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21454,null,"See CPT",null,847.65600000000006,null,847.65600000000006,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E680,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F680,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A680=1,IF(F680=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21461,null,"See CPT",null,3634.962,null,1906.6469999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E681,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F681,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A681=1,IF(F681=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21462,null,"See CPT",null,3939.5160000000001,null,2113.9289999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E682,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F682,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A682=1,IF(F682=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21465,null,"See CPT",null,1382.6519999999998,null,1382.6519999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E683,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F683,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A683=1,IF(F683=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21470,null,"See CPT",null,2013.7619999999999,null,2013.7619999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E684,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F684,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A684=1,IF(F684=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21480,null,"See CPT",null,249.54899999999998,null,53.268000000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E685,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F685,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A685=1,IF(F685=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21485,null,"See CPT",null,1773.4769999999999,null,1438.2359999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E686,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F686,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A686=1,IF(F686=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21490,null,"See CPT",null,1362.3869999999999,null,1362.3869999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E687,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F687,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A687=1,IF(F687=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21497,null,"See CPT",null,1296.9599999999998,null,1072.8869999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E688,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F688,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A688=1,IF(F688=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E689,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F689,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A689=1,IF(F689=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21501,null,"See CPT",null,883.55399999999997,null,583.053,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E690,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F690,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A690=1,IF(F690=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21502,null,"See CPT",null,882.97500000000002,null,882.97500000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E691,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F691,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A691=1,IF(F691=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21510,null,"See CPT",null,788.59799999999996,null,788.59799999999996,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E692,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F692,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A692=1,IF(F692=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21550,null,"See CPT",null,493.88699999999994,null,273.28799999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E693,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F693,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A693=1,IF(F693=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21552,null,"See CPT",null,774.702,null,774.702,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E694,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F694,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A694=1,IF(F694=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21554,null,"See CPT",null,1266.8519999999999,null,1266.8519999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E695,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F695,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A695=1,IF(F695=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21555,null,"See CPT",null,784.54500000000007,null,536.73299999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E696,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F696,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A696=1,IF(F696=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21556,null,"See CPT",null,928.13700000000006,null,928.13700000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E697,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F697,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A697=1,IF(F697=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21557,null,"See CPT",null,1655.3609999999999,null,1655.3609999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E698,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F698,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A698=1,IF(F698=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E699,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F699,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A699=1,IF(F699=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21600,null,"See CPT",null,971.56200000000001,null,971.56200000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E700,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F700,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A700=1,IF(F700=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21601,null,"See CPT",null,2023.605,null,2023.605,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E701,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F701,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A701=1,IF(F701=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21602,null,"See CPT",null,2745.0389999999998,null,2745.0389999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E702,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F702,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A702=1,IF(F702=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21603,null,"See CPT",null,2987.64,null,2987.64,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E703,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F703,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A703=1,IF(F703=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21610,null,"See CPT",null,2064.1349999999998,null,2064.1349999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E704,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F704,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A704=1,IF(F704=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21615,null,"See CPT",null,1051.4639999999999,null,1051.4639999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E705,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F705,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A705=1,IF(F705=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21616,null,"See CPT",null,1210.6890000000001,null,1210.6890000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E706,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F706,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A706=1,IF(F706=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21620,null,"See CPT",null,881.23800000000006,null,881.23800000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E707,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F707,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A707=1,IF(F707=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21627,null,"See CPT",null,943.77,null,943.77,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E708,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F708,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A708=1,IF(F708=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21630,null,"See CPT",null,2054.8710000000001,null,2054.8710000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E709,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F709,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A709=1,IF(F709=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21632,null,"See CPT",null,2080.9259999999999,null,2080.9259999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E710,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F710,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A710=1,IF(F710=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E711,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F711,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A711=1,IF(F711=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21700,null,"See CPT",null,606.21299999999997,null,606.21299999999997,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E712,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F712,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A712=1,IF(F712=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A712=1,IF(F712=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21705,null,"See CPT",null,902.66099999999994,null,902.66099999999994,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E713,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F713,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A713=1,IF(F713=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21720,null,"See CPT",null,919.452,null,919.452,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E714,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F714,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A714=1,IF(F714=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21725,null,"See CPT",null,944.34899999999993,null,944.34899999999993,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E715,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F715,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A715=1,IF(F715=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21740,null,"See CPT",null,1754.9489999999998,null,1754.9489999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E716,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F716,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A716=1,IF(F716=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21742,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E717,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F717,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A717=1,IF(F717=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21743,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E718,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F718,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A718=1,IF(F718=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21750,null,"See CPT",null,1161.4739999999999,null,1161.4739999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E719,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F719,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A719=1,IF(F719=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21811,null,"See CPT",null,1009.7760000000001,null,1009.7760000000001,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E720,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F720,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A720=1,IF(F720=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21812,null,"See CPT",null,1224.5849999999998,null,1224.5849999999998,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E721,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F721,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A721=1,IF(F721=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21813,null,"See CPT",null,1673.31,null,1673.31,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E722,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F722,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A722=1,IF(F722=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21820,null,"See CPT",null,265.18200000000002,null,260.55,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E723,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F723,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A723=1,IF(F723=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21825,null,"See CPT",null,948.98099999999999,null,948.98099999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E724,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F724,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A724=1,IF(F724=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E725,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F725,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A725=1,IF(F725=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21920,null,"See CPT",null,477.67500000000001,null,272.709,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E726,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F726,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A726=1,IF(F726=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21925,null,"See CPT",null,863.28899999999999,null,644.42700000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E727,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F727,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A727=1,IF(F727=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21930,null,"See CPT",null,895.71299999999997,null,632.84699999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E728,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F728,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A728=1,IF(F728=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21931,null,"See CPT",null,814.65300000000002,null,814.65300000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E729,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F729,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A729=1,IF(F729=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21932,null,"See CPT",null,1146.9989999999998,null,1146.9989999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E730,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F730,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A730=1,IF(F730=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21933,null,"See CPT",null,1274.9579999999999,null,1274.9579999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E731,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F731,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A731=1,IF(F731=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},21935,null,"See CPT",null,1768.845,null,1768.845,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E732,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F732,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A732=1,IF(F732=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E733,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F733,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A733=1,IF(F733=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22010,null,"See CPT",null,1673.8889999999999,null,1673.8889999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E734,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F734,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A734=1,IF(F734=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22015,null,"See CPT",null,1641.4650000000001,null,1641.4650000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E735,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F735,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A735=1,IF(F735=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22100,null,"See CPT",null,1498.452,null,1498.452,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E736,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F736,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A736=1,IF(F736=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22101,null,"See CPT",null,1503.663,null,1503.663,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E737,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F737,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A737=1,IF(F737=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22102,null,"See CPT",null,1439.394,null,1439.394,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E738,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F738,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A738=1,IF(F738=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22103,null,"See CPT",null,238.548,null,238.548,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E739,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F739,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A739=1,IF(F739=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22110,null,"See CPT",null,1816.9019999999998,null,1816.9019999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E740,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F740,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A740=1,IF(F740=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22112,null,"See CPT",null,1948.3349999999998,null,1948.3349999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E741,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F741,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A741=1,IF(F741=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22114,null,"See CPT",null,1948.3349999999998,null,1948.3349999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E742,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F742,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A742=1,IF(F742=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22116,null,"See CPT",null,239.12699999999998,null,239.12699999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E743,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F743,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A743=1,IF(F743=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22206,null,"See CPT",null,4185.5910000000003,null,4185.5910000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E744,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F744,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A744=1,IF(F744=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22207,null,"See CPT",null,4102.7939999999999,null,4102.7939999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E745,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F745,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A745=1,IF(F745=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22208,null,"See CPT",null,994.72199999999998,null,994.72199999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E746,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F746,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A746=1,IF(F746=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22210,null,"See CPT",null,3084.3330000000001,null,3084.3330000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E747,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F747,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A747=1,IF(F747=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22212,null,"See CPT",null,2595.078,null,2595.078,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E748,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F748,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A748=1,IF(F748=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22214,null,"See CPT",null,2600.8679999999999,null,2600.8679999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E749,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F749,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A749=1,IF(F749=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22216,null,"See CPT",null,617.21399999999994,null,617.21399999999994,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E750,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F750,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A750=1,IF(F750=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22220,null,"See CPT",null,2788.4639999999999,null,2788.4639999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E751,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F751,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A751=1,IF(F751=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22222,null,"See CPT",null,3010.221,null,3010.221,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E752,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F752,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A752=1,IF(F752=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22224,null,"See CPT",null,2739.828,null,2739.828,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E753,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F753,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A753=1,IF(F753=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22226,null,"See CPT",null,613.16099999999994,null,613.16099999999994,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E754,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F754,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A754=1,IF(F754=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22310,null,"See CPT",null,541.36500000000001,null,517.04700000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E755,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F755,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A755=1,IF(F755=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22315,null,"See CPT",null,1551.72,null,1342.1219999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E756,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F756,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A756=1,IF(F756=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22318,null,"See CPT",null,2813.3610000000003,null,2813.3610000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E757,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F757,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A757=1,IF(F757=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22319,null,"See CPT",null,3129.4949999999999,null,3129.4949999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E758,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F758,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A758=1,IF(F758=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22325,null,"See CPT",null,2525.598,null,2525.598,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E759,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F759,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A759=1,IF(F759=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22326,null,"See CPT",null,2584.6559999999999,null,2584.6559999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E760,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F760,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A760=1,IF(F760=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22327,null,"See CPT",null,2630.9759999999997,null,2630.9759999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E761,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F761,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A761=1,IF(F761=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22328,null,"See CPT",null,475.93800000000005,null,475.93800000000005,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E762,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F762,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A762=1,IF(F762=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22505,null,"See CPT",null,224.65199999999999,null,224.65199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E763,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F763,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A763=1,IF(F763=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E764,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F764,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A764=1,IF(F764=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E765,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F765,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A765=1,IF(F765=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22512,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E766,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F766,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A766=1,IF(F766=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E767,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F767,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A767=1,IF(F767=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E768,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F768,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A768=1,IF(F768=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22515,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E769,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F769,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A769=1,IF(F769=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E770,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F770,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A770=1,IF(F770=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22527,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E771,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F771,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A771=1,IF(F771=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22532,null,"See CPT",null,3083.1749999999997,null,3083.1749999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E772,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F772,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A772=1,IF(F772=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22533,null,"See CPT",null,2848.6800000000003,null,2848.6800000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E773,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F773,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A773=1,IF(F773=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22534,null,"See CPT",null,609.10799999999995,null,609.10799999999995,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E774,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F774,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A774=1,IF(F774=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22548,null,"See CPT",null,3357.6210000000001,null,3357.6210000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E775,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F775,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A775=1,IF(F775=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22551,null,"See CPT",null,2918.16,null,2918.16,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E776,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F776,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A776=1,IF(F776=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A776=1,IF(F776=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22552,null,"See CPT",null,671.06099999999992,null,671.06099999999992,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E777,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F777,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A777=1,IF(F777=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22554,null,"See CPT",null,2166.6179999999999,null,2166.6179999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E778,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F778,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A778=1,IF(F778=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22556,null,"See CPT",null,2857.944,null,2857.944,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E779,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F779,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A779=1,IF(F779=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22558,null,"See CPT",null,2626.3440000000001,null,2626.3440000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E780,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F780,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A780=1,IF(F780=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22585,null,"See CPT",null,552.94500000000005,null,552.94500000000005,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E781,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F781,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A781=1,IF(F781=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22586,null,"See CPT",null,3474.5789999999997,null,3474.5789999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E782,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F782,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A782=1,IF(F782=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22590,null,"See CPT",null,2718.4050000000002,null,2718.4050000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E783,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F783,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A783=1,IF(F783=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22595,null,"See CPT",null,2595.6569999999997,null,2595.6569999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E784,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F784,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A784=1,IF(F784=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22600,null,"See CPT",null,2233.7819999999997,null,2233.7819999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E785,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F785,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A785=1,IF(F785=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22610,null,"See CPT",null,2198.4629999999997,null,2198.4629999999997,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E786,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F786,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A786=1,IF(F786=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22612,null,"See CPT",null,2725.9319999999998,null,2725.9319999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E787,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F787,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A787=1,IF(F787=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22614,null,"See CPT",null,661.21799999999996,null,661.21799999999996,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E788,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F788,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A788=1,IF(F788=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22630,null,"See CPT",null,2712.6150000000002,null,2712.6150000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E789,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F789,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A789=1,IF(F789=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22632,null,"See CPT",null,541.36500000000001,null,541.36500000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E790,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F790,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A790=1,IF(F790=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22633,null,"See CPT",null,3171.183,null,3171.183,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E791,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F791,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A791=1,IF(F791=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22634,null,"See CPT",null,838.971,null,838.971,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E792,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F792,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A792=1,IF(F792=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22800,null,"See CPT",null,2338.5810000000001,null,2338.5810000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E793,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F793,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A793=1,IF(F793=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22802,null,"See CPT",null,3628.5929999999998,null,3628.5929999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E794,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F794,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A794=1,IF(F794=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22804,null,"See CPT",null,4168.8,null,4168.8,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E795,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F795,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A795=1,IF(F795=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22808,null,"See CPT",null,3127.7580000000003,null,3127.7580000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E796,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F796,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A796=1,IF(F796=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22810,null,"See CPT",null,3570.1139999999996,null,3570.1139999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E797,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F797,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A797=1,IF(F797=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22812,null,"See CPT",null,3786.0810000000001,null,3786.0810000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E798,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F798,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A798=1,IF(F798=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22818,null,"See CPT",null,3696.915,null,3696.915,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E799,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F799,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A799=1,IF(F799=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22819,null,"See CPT",null,4256.2290000000003,null,4256.2290000000003,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E800,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F800,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A800=1,IF(F800=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22830,null,"See CPT",null,1419.1290000000001,null,1419.1290000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E801,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F801,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A801=1,IF(F801=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22840,null,"See CPT",null,1285.3799999999999,null,1285.3799999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E802,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F802,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A802=1,IF(F802=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22841,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E803,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F803,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A803=1,IF(F803=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22842,null,"See CPT",null,1290.5909999999999,null,1290.5909999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E804,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F804,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A804=1,IF(F804=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22843,null,"See CPT",null,1380.336,null,1380.336,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E805,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F805,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A805=1,IF(F805=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22844,null,"See CPT",null,1674.4680000000001,null,1674.4680000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E806,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F806,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A806=1,IF(F806=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22845,null,"See CPT",null,1232.1120000000001,null,1232.1120000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E807,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F807,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A807=1,IF(F807=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22846,null,"See CPT",null,1279.5900000000001,null,1279.5900000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E808,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F808,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A808=1,IF(F808=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22847,null,"See CPT",null,1366.44,null,1366.44,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E809,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F809,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A809=1,IF(F809=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22848,null,"See CPT",null,609.6869999999999,null,609.6869999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E810,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F810,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A810=1,IF(F810=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22849,null,"See CPT",null,2246.52,null,2246.52,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E811,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F811,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A811=1,IF(F811=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22850,null,"See CPT",null,1270.326,null,1270.326,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E812,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F812,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A812=1,IF(F812=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22852,null,"See CPT",null,1222.269,null,1222.269,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E813,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F813,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A813=1,IF(F813=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22853,null,"See CPT",null,435.98700000000002,null,435.98700000000002,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E814,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F814,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A814=1,IF(F814=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22854,null,"See CPT",null,566.26199999999994,null,566.26199999999994,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E815,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F815,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A815=1,IF(F815=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22855,null,"See CPT",null,1911.2789999999998,null,1911.2789999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E816,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F816,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A816=1,IF(F816=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22856,null,"See CPT",null,2797.7280000000001,null,2797.7280000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E817,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F817,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A817=1,IF(F817=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22857,null,"See CPT",null,3042.645,null,3042.645,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E818,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F818,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A818=1,IF(F818=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22858,null,"See CPT",null,859.81499999999994,null,859.81499999999994,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E819,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F819,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A819=1,IF(F819=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22859,null,"See CPT",null,565.68299999999999,null,565.68299999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E820,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F820,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A820=1,IF(F820=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22861,null,"See CPT",null,3950.5170000000003,null,3950.5170000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E821,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F821,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A821=1,IF(F821=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22862,null,"See CPT",null,3953.4119999999998,null,3953.4119999999998,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E822,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F822,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A822=1,IF(F822=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22864,null,"See CPT",null,3529.5839999999998,null,3529.5839999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E823,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F823,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A823=1,IF(F823=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22865,null,"See CPT",null,3859.6139999999996,null,3859.6139999999996,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E824,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F824,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A824=1,IF(F824=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22867,null,"See CPT",null,1697.6279999999999,null,1697.6279999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E825,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F825,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A825=1,IF(F825=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22868,null,"See CPT",null,413.98500000000001,null,413.98500000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E826,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F826,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A826=1,IF(F826=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22869,null,"See CPT",null,772.38599999999997,null,772.38599999999997,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E827,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F827,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A827=1,IF(F827=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22870,null,"See CPT",null,209.01899999999998,null,209.01899999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E828,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F828,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A828=1,IF(F828=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E829,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F829,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A829=1,IF(F829=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22900,null,"See CPT",null,979.66800000000012,null,979.66800000000012,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E830,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F830,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A830=1,IF(F830=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22901,null,"See CPT",null,1153.9469999999999,null,1153.9469999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E831,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F831,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A831=1,IF(F831=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22902,null,"See CPT",null,844.18200000000002,null,580.73699999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E832,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F832,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A832=1,IF(F832=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22903,null,"See CPT",null,764.28,null,764.28,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E833,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F833,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A833=1,IF(F833=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E834,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F834,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A834=1,IF(F834=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E835,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F835,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A835=1,IF(F835=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},22999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E836,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F836,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A836=1,IF(F836=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23000,null,"See CPT",null,1031.1989999999998,null,634.005,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E837,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F837,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A837=1,IF(F837=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23020,null,"See CPT",null,1200.8459999999998,null,1200.8459999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E838,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F838,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A838=1,IF(F838=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23030,null,"See CPT",null,808.86300000000006,null,441.19799999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E839,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F839,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A839=1,IF(F839=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23031,null,"See CPT",null,782.22899999999993,null,379.245,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E840,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F840,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A840=1,IF(F840=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A840=1,IF(F840=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23035,null,"See CPT",null,1188.6870000000001,null,1188.6870000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E841,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F841,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A841=1,IF(F841=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23040,null,"See CPT",null,1249.482,null,1249.482,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E842,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F842,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A842=1,IF(F842=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23044,null,"See CPT",null,984.3,null,984.3,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E843,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F843,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A843=1,IF(F843=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E844,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F844,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A844=1,IF(F844=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23066,null,"See CPT",null,1045.095,null,643.84799999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E845,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F845,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A845=1,IF(F845=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23071,null,"See CPT",null,730.11899999999991,null,730.11899999999991,null,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E846,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F846,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A846=1,IF(F846=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23073,null,"See CPT",null,1206.636,null,1206.636,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E847,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F847,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A847=1,IF(F847=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23075,null,"See CPT",null,931.61099999999999,null,572.63099999999997,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E848,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F848,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A848=1,IF(F848=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23076,null,"See CPT",null,942.0329999999999,null,942.0329999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E849,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F849,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A849=1,IF(F849=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E850,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F850,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A850=1,IF(F850=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E851,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F851,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A851=1,IF(F851=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23100,null,"See CPT",null,885.87,null,885.87,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E852,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F852,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A852=1,IF(F852=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23101,null,"See CPT",null,800.75699999999995,null,800.75699999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E853,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F853,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A853=1,IF(F853=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23105,null,"See CPT",null,1120.365,null,1120.365,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E854,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F854,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A854=1,IF(F854=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23106,null,"See CPT",null,878.92199999999991,null,878.92199999999991,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E855,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F855,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A855=1,IF(F855=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23107,null,"See CPT",null,1153.9469999999999,null,1153.9469999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E856,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F856,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A856=1,IF(F856=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23120,null,"See CPT",null,1026.567,null,1026.567,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E857,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F857,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A857=1,IF(F857=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23125,null,"See CPT",null,1236.165,null,1236.165,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E858,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F858,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A858=1,IF(F858=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23130,null,"See CPT",null,1080.9930000000002,null,1080.9930000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E859,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F859,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A859=1,IF(F859=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23140,null,"See CPT",null,970.40400000000011,null,970.40400000000011,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E860,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F860,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A860=1,IF(F860=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23145,null,"See CPT",null,1212.4259999999999,null,1212.4259999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E861,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F861,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A861=1,IF(F861=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23146,null,"See CPT",null,1089.6779999999999,null,1089.6779999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E862,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F862,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A862=1,IF(F862=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23150,null,"See CPT",null,1148.7359999999999,null,1148.7359999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E863,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F863,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A863=1,IF(F863=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23155,null,"See CPT",null,1387.8629999999998,null,1387.8629999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E864,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F864,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A864=1,IF(F864=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23156,null,"See CPT",null,1184.0549999999998,null,1184.0549999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E865,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F865,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A865=1,IF(F865=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23170,null,"See CPT",null,986.61599999999987,null,986.61599999999987,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E866,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F866,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A866=1,IF(F866=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23172,null,"See CPT",null,996.45900000000006,null,996.45900000000006,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E867,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F867,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A867=1,IF(F867=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23174,null,"See CPT",null,1331.1209999999999,null,1331.1209999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E868,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F868,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A868=1,IF(F868=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23180,null,"See CPT",null,1156.2629999999999,null,1156.2629999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E869,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F869,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A869=1,IF(F869=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23182,null,"See CPT",null,1171.896,null,1171.896,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E870,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F870,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A870=1,IF(F870=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23184,null,"See CPT",null,1288.854,null,1288.854,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E871,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F871,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A871=1,IF(F871=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23190,null,"See CPT",null,1005.7230000000001,null,1005.7230000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E872,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F872,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A872=1,IF(F872=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23195,null,"See CPT",null,1299.855,null,1299.855,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E873,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F873,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A873=1,IF(F873=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E874,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F874,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A874=1,IF(F874=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E875,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F875,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A875=1,IF(F875=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E876,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F876,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A876=1,IF(F876=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23330,null,"See CPT",null,545.99699999999996,null,292.39499999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E877,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F877,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A877=1,IF(F877=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23333,null,"See CPT",null,828.54899999999998,null,828.54899999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E878,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F878,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A878=1,IF(F878=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23334,null,"See CPT",null,1844.694,null,1844.694,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E879,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F879,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A879=1,IF(F879=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23335,null,"See CPT",null,2187.462,null,2187.462,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E880,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F880,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A880=1,IF(F880=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23350,null,"See CPT",null,300.50100000000003,null,85.691999999999993,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E881,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F881,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A881=1,IF(F881=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23395,null,"See CPT",null,2216.4119999999998,null,2216.4119999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E882,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F882,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A882=1,IF(F882=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23397,null,"See CPT",null,1955.8620000000001,null,1955.8620000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E883,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F883,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A883=1,IF(F883=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23400,null,"See CPT",null,1687.7849999999999,null,1687.7849999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E884,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F884,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A884=1,IF(F884=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23405,null,"See CPT",null,1081.5719999999999,null,1081.5719999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E885,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F885,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A885=1,IF(F885=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23406,null,"See CPT",null,1322.4359999999999,null,1322.4359999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E886,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F886,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A886=1,IF(F886=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23410,null,"See CPT",null,1423.761,null,1423.761,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E887,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F887,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A887=1,IF(F887=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23412,null,"See CPT",null,1479.924,null,1479.924,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E888,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F888,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A888=1,IF(F888=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23415,null,"See CPT",null,1216.479,null,1216.479,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E889,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F889,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A889=1,IF(F889=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23420,null,"See CPT",null,1690.1010000000001,null,1690.1010000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E890,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F890,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A890=1,IF(F890=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23430,null,"See CPT",null,1295.8019999999999,null,1295.8019999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E891,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F891,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A891=1,IF(F891=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23440,null,"See CPT",null,1313.172,null,1313.172,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E892,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F892,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A892=1,IF(F892=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23450,null,"See CPT",null,1639.1489999999999,null,1639.1489999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E893,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F893,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A893=1,IF(F893=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23455,null,"See CPT",null,1719.0509999999999,null,1719.0509999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E894,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F894,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A894=1,IF(F894=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23460,null,"See CPT",null,1887.54,null,1887.54,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E895,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F895,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A895=1,IF(F895=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23462,null,"See CPT",null,1847.0099999999998,null,1847.0099999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E896,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F896,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A896=1,IF(F896=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23465,null,"See CPT",null,1935.018,null,1935.018,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E897,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F897,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A897=1,IF(F897=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23466,null,"See CPT",null,1937.3340000000001,null,1937.3340000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E898,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F898,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A898=1,IF(F898=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23470,null,"See CPT",null,2073.9780000000001,null,2073.9780000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E899,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F899,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A899=1,IF(F899=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23472,null,"See CPT",null,2494.9110000000001,null,2494.9110000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E900,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F900,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A900=1,IF(F900=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23473,null,"See CPT",null,2780.9369999999999,null,2780.9369999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E901,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F901,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A901=1,IF(F901=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23474,null,"See CPT",null,2997.4830000000002,null,2997.4830000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E902,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F902,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A902=1,IF(F902=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23480,null,"See CPT",null,1424.9189999999999,null,1424.9189999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E903,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F903,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A903=1,IF(F903=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23485,null,"See CPT",null,1643.7809999999999,null,1643.7809999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E904,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F904,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A904=1,IF(F904=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A904=1,IF(F904=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23490,null,"See CPT",null,1493.82,null,1493.82,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E905,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F905,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A905=1,IF(F905=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23491,null,"See CPT",null,1760.739,null,1760.739,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E906,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F906,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A906=1,IF(F906=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23500,null,"See CPT",null,396.036,null,404.142,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E907,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F907,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A907=1,IF(F907=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23505,null,"See CPT",null,635.74199999999996,null,589.42200000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E908,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F908,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A908=1,IF(F908=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23515,null,"See CPT",null,1254.114,null,1254.114,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E909,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F909,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A909=1,IF(F909=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23520,null,"See CPT",null,427.88099999999997,null,423.24899999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E910,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F910,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A910=1,IF(F910=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23525,null,"See CPT",null,702.90600000000006,null,640.95299999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E911,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F911,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A911=1,IF(F911=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23530,null,"See CPT",null,1006.3019999999999,null,1006.3019999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E912,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F912,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A912=1,IF(F912=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23532,null,"See CPT",null,1093.731,null,1093.731,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E913,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F913,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A913=1,IF(F913=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23540,null,"See CPT",null,420.93299999999999,null,416.30099999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E914,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F914,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A914=1,IF(F914=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23545,null,"See CPT",null,621.846,null,556.99799999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E915,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F915,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A915=1,IF(F915=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23550,null,"See CPT",null,999.35400000000004,null,999.35400000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E916,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F916,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A916=1,IF(F916=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23552,null,"See CPT",null,1141.788,null,1141.788,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E917,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F917,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A917=1,IF(F917=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23570,null,"See CPT",null,417.459,null,430.19699999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E918,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F918,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A918=1,IF(F918=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23575,null,"See CPT",null,725.48699999999997,null,669.32400000000007,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E919,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F919,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A919=1,IF(F919=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23585,null,"See CPT",null,1689.5219999999999,null,1689.5219999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E920,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F920,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A920=1,IF(F920=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23600,null,"See CPT",null,594.63299999999992,null,560.47199999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E921,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F921,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A921=1,IF(F921=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23605,null,"See CPT",null,835.49699999999996,null,754.4369999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E922,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F922,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A922=1,IF(F922=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23615,null,"See CPT",null,1533.771,null,1533.771,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E923,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F923,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A923=1,IF(F923=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23616,null,"See CPT",null,2133.0360000000001,null,2133.0360000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E924,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F924,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A924=1,IF(F924=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23620,null,"See CPT",null,482.30700000000002,null,462.04200000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E925,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F925,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A925=1,IF(F925=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23625,null,"See CPT",null,678.58799999999997,null,621.26700000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E926,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F926,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A926=1,IF(F926=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23630,null,"See CPT",null,1356.597,null,1356.597,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E927,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F927,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A927=1,IF(F927=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23650,null,"See CPT",null,579.57899999999995,null,521.67899999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E928,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F928,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A928=1,IF(F928=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23655,null,"See CPT",null,719.697,null,719.697,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E929,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F929,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A929=1,IF(F929=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23660,null,"See CPT",null,1023.6719999999999,null,1023.6719999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E930,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F930,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A930=1,IF(F930=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23665,null,"See CPT",null,765.43799999999999,null,702.90600000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E931,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F931,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A931=1,IF(F931=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23670,null,"See CPT",null,1511.19,null,1511.19,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E932,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F932,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A932=1,IF(F932=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23675,null,"See CPT",null,975.03599999999994,null,878.92199999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E933,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F933,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A933=1,IF(F933=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23680,null,"See CPT",null,1607.883,null,1607.883,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E934,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F934,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A934=1,IF(F934=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23700,null,"See CPT",null,341.03099999999995,null,341.03099999999995,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E935,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F935,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A935=1,IF(F935=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23800,null,"See CPT",null,1779.8459999999998,null,1779.8459999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E936,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F936,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A936=1,IF(F936=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23802,null,"See CPT",null,2217.5699999999997,null,2217.5699999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E937,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F937,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A937=1,IF(F937=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23900,null,"See CPT",null,2389.5329999999999,null,2389.5329999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E938,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F938,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A938=1,IF(F938=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23920,null,"See CPT",null,1943.124,null,1943.124,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E939,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F939,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A939=1,IF(F939=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23921,null,"See CPT",null,824.49599999999998,null,824.49599999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E940,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F940,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A940=1,IF(F940=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23929,null,"See CPT",null,0,null,0,null,"000",0,0,0,0,2,0,2,1,1,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E941,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F941,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A941=1,IF(F941=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23930,null,"See CPT",null,664.11300000000006,null,375.19200000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E942,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F942,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A942=1,IF(F942=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23931,null,"See CPT",null,559.89300000000003,null,281.39400000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E943,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F943,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A943=1,IF(F943=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},23935,null,"See CPT",null,895.13400000000001,null,895.13400000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E944,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F944,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A944=1,IF(F944=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24000,null,"See CPT",null,834.91800000000001,null,834.91800000000001,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E945,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F945,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A945=1,IF(F945=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24006,null,"See CPT",null,1239.06,null,1239.06,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E946,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F946,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A946=1,IF(F946=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24065,null,"See CPT",null,472.464,null,285.447,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E947,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F947,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A947=1,IF(F947=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24066,null,"See CPT",null,1131.9449999999999,null,732.43500000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E948,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F948,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A948=1,IF(F948=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24071,null,"See CPT",null,706.38,null,706.38,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E949,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F949,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A949=1,IF(F949=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24073,null,"See CPT",null,1202.0040000000001,null,1202.0040000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E950,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F950,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A950=1,IF(F950=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24075,null,"See CPT",null,966.351,null,574.947,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E951,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F951,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A951=1,IF(F951=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24076,null,"See CPT",null,946.66500000000008,null,946.66500000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E952,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F952,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A952=1,IF(F952=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E953,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F953,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A953=1,IF(F953=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E954,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F954,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A954=1,IF(F954=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24100,null,"See CPT",null,736.48800000000006,null,736.48800000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E955,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F955,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A955=1,IF(F955=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24101,null,"See CPT",null,882.39599999999996,null,882.39599999999996,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E956,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F956,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A956=1,IF(F956=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24102,null,"See CPT",null,1078.6769999999999,null,1078.6769999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E957,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F957,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A957=1,IF(F957=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24105,null,"See CPT",null,632.84699999999998,null,632.84699999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E958,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F958,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A958=1,IF(F958=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24110,null,"See CPT",null,1014.9870000000001,null,1014.9870000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E959,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F959,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A959=1,IF(F959=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24115,null,"See CPT",null,1284.222,null,1284.222,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E960,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F960,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A960=1,IF(F960=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24116,null,"See CPT",null,1493.82,null,1493.82,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E961,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F961,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A961=1,IF(F961=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24120,null,"See CPT",null,932.19,null,932.19,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E962,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F962,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A962=1,IF(F962=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24125,null,"See CPT",null,1087.941,null,1087.941,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E963,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F963,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A963=1,IF(F963=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24126,null,"See CPT",null,1135.4189999999999,null,1135.4189999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E964,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F964,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A964=1,IF(F964=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24130,null,"See CPT",null,893.976,null,893.976,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E965,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F965,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A965=1,IF(F965=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24134,null,"See CPT",null,1301.0129999999999,null,1301.0129999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E966,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F966,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A966=1,IF(F966=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24136,null,"See CPT",null,1104.732,null,1104.732,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E967,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F967,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A967=1,IF(F967=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24138,null,"See CPT",null,1200.2670000000001,null,1200.2670000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E968,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F968,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A968=1,IF(F968=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A968=1,IF(F968=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24140,null,"See CPT",null,1225.7430000000002,null,1225.7430000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E969,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F969,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A969=1,IF(F969=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24145,null,"See CPT",null,1039.3049999999998,null,1039.3049999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E970,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F970,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A970=1,IF(F970=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24147,null,"See CPT",null,1101.837,null,1101.837,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E971,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F971,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A971=1,IF(F971=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24149,null,"See CPT",null,2042.133,null,2042.133,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E972,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F972,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A972=1,IF(F972=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E973,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F973,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A973=1,IF(F973=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E974,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F974,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A974=1,IF(F974=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24155,null,"See CPT",null,1478.7659999999998,null,1478.7659999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E975,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F975,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A975=1,IF(F975=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24160,null,"See CPT",null,2170.6710000000003,null,2170.6710000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E976,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F976,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A976=1,IF(F976=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24164,null,"See CPT",null,1252.9559999999999,null,1252.9559999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E977,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F977,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A977=1,IF(F977=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24200,null,"See CPT",null,402.40499999999997,null,248.96999999999997,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E978,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F978,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A978=1,IF(F978=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24201,null,"See CPT",null,997.0379999999999,null,638.05799999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E979,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F979,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A979=1,IF(F979=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24220,null,"See CPT",null,351.45300000000003,null,114.063,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E980,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F980,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A980=1,IF(F980=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24300,null,"See CPT",null,766.596,null,766.596,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E981,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F981,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A981=1,IF(F981=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24301,null,"See CPT",null,1305.645,null,1305.645,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E982,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F982,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A982=1,IF(F982=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24305,null,"See CPT",null,1011.5129999999999,null,1011.5129999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E983,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F983,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A983=1,IF(F983=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24310,null,"See CPT",null,829.70699999999999,null,829.70699999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E984,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F984,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A984=1,IF(F984=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24320,null,"See CPT",null,1357.1759999999999,null,1357.1759999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E985,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F985,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A985=1,IF(F985=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24330,null,"See CPT",null,1250.6400000000001,null,1250.6400000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E986,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F986,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A986=1,IF(F986=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24331,null,"See CPT",null,1365.8609999999999,null,1365.8609999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E987,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F987,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A987=1,IF(F987=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24332,null,"See CPT",null,1075.7819999999999,null,1075.7819999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E988,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F988,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A988=1,IF(F988=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24340,null,"See CPT",null,1080.9930000000002,null,1080.9930000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E989,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F989,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A989=1,IF(F989=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24341,null,"See CPT",null,1302.1709999999998,null,1302.1709999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E990,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F990,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A990=1,IF(F990=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24342,null,"See CPT",null,1347.912,null,1347.912,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E991,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F991,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A991=1,IF(F991=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24343,null,"See CPT",null,1244.8499999999999,null,1244.8499999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E992,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F992,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A992=1,IF(F992=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24344,null,"See CPT",null,1896.8039999999999,null,1896.8039999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E993,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F993,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A993=1,IF(F993=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24345,null,"See CPT",null,1236.7439999999999,null,1236.7439999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E994,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F994,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A994=1,IF(F994=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24346,null,"See CPT",null,1914.7529999999999,null,1914.7529999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E995,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F995,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A995=1,IF(F995=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24357,null,"See CPT",null,737.06700000000001,null,737.06700000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E996,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F996,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A996=1,IF(F996=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24358,null,"See CPT",null,922.92599999999993,null,922.92599999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E997,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F997,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A997=1,IF(F997=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24359,null,"See CPT",null,1153.9469999999999,null,1153.9469999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E998,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F998,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A998=1,IF(F998=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24360,null,"See CPT",null,1566.7739999999999,null,1566.7739999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E999,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F999,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A999=1,IF(F999=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24361,null,"See CPT",null,1746.2639999999999,null,1746.2639999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1000,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1000,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1000=1,IF(F1000=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24362,null,"See CPT",null,1837.1669999999999,null,1837.1669999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1016,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1016,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1016=1,IF(F1016=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24515,null,"See CPT",null,1529.1389999999999,null,1529.1389999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1023,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1023,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1023=1,IF(F1023=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},24560,null,"See CPT",null,596.37,null,525.73199999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1038,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1038,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1038=1,IF(F1038=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1070,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1070,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1070=1,IF(F1070=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25075,null,"See CPT",null,944.34899999999993,null,551.78699999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1081,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1081,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1081=1,IF(F1081=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25111,null,"See CPT",null,570.89400000000001,null,570.89400000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1095,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1095,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1095=1,IF(F1095=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25151,null,"See CPT",null,1021.356,null,1021.356,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1124,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1124,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1124=1,IF(F1124=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1142,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1142,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1142=1,IF(F1142=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25426,null,"See CPT",null,1943.703,null,1943.703,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1148,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1148,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1148=1,IF(F1148=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25443,null,"See CPT",null,1366.44,null,1366.44,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1171,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1171,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1171=1,IF(F1171=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25575,null,"See CPT",null,1571.4059999999999,null,1571.4059999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1185,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1185,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1185=1,IF(F1185=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},25651,null,"See CPT",null,860.39399999999989,null,860.39399999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1218,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1218,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1218=1,IF(F1218=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26030,null,"See CPT",null,856.34099999999989,null,856.34099999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1228,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1228,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1228=1,IF(F1228=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26080,null,"See CPT",null,700.58999999999992,null,700.58999999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1243,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1243,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1243=1,IF(F1243=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26140,null,"See CPT",null,888.76499999999999,null,888.76499999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1268,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1268,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1268=1,IF(F1268=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26372,null,"See CPT",null,1644.9390000000001,null,1644.9390000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1289,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1289,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1289=1,IF(F1289=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26455,null,"See CPT",null,808.86300000000006,null,808.86300000000006,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1297,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1297,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1297=1,IF(F1297=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26480,null,"See CPT",null,1413.3389999999999,null,1413.3389999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1332,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1332,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1332=1,IF(F1332=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26556,null,"See CPT",null,5914.4850000000006,null,5914.4850000000006,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1340,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1340,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1340=1,IF(F1340=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1356,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1356,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1356=1,IF(F1356=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26676,null,"See CPT",null,899.1869999999999,null,899.1869999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1387,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1387,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1387=1,IF(F1387=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},26862,null,"See CPT",null,1362.3869999999999,null,1362.3869999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1399,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1399,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1399=1,IF(F1399=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27005,null,"See CPT",null,1250.6400000000001,null,1250.6400000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1416,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1416,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A1416=1,IF(F1416=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A1416=1,IF(F1416=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27054,null,"See CPT",null,1199.1089999999999,null,1199.1089999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1436,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1436,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1436=1,IF(F1436=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27095,null,"See CPT",null,588.84299999999996,null,141.85500000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1445,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1445,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1445=1,IF(F1445=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27122,null,"See CPT",null,1907.8050000000001,null,1907.8050000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1479,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1479,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1479=1,IF(F1479=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27226,null,"See CPT",null,1826.7449999999999,null,1826.7449999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1488,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1488,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1488=1,IF(F1488=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27244,null,"See CPT",null,2120.2979999999998,null,2120.2979999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1513,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1513,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1513=1,IF(F1513=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27299,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1521,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1521,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1521=1,IF(F1521=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27324,null,"See CPT",null,712.17000000000007,null,712.17000000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1542,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1542,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1542=1,IF(F1542=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27358,null,"See CPT",null,468.411,null,468.411,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1564,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1564,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1564=1,IF(F1564=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27409,null,"See CPT",null,1677.3629999999998,null,1677.3629999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1585,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1585,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1585=1,IF(F1585=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27446,null,"See CPT",null,1991.181,null,1991.181,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1607,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1607,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1607=1,IF(F1607=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27498,null,"See CPT",null,1146.42,null,1146.42,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1614,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1614,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1614=1,IF(F1614=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27507,null,"See CPT",null,1672.731,null,1672.731,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1644,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1644,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1644=1,IF(F1644=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27592,null,"See CPT",null,1150.473,null,1150.473,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1661,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1661,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1661=1,IF(F1661=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1668,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1668,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1668=1,IF(F1668=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27630,null,"See CPT",null,990.66899999999998,null,628.21499999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1690,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1690,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1690=1,IF(F1690=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27680,null,"See CPT",null,731.27700000000004,null,731.27700000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1711,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1711,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1711=1,IF(F1711=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27722,null,"See CPT",null,1553.4569999999999,null,1553.4569999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1733,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1733,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1733=1,IF(F1733=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27780,null,"See CPT",null,553.524,null,506.625,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1740,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1740,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1740=1,IF(F1740=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27810,null,"See CPT",null,836.65499999999997,null,750.38400000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1772,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1772,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1772=1,IF(F1772=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},27899,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1787,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1787,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1787=1,IF(F1787=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28045,null,"See CPT",null,865.02599999999995,null,599.26499999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1796,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1796,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1796=1,IF(F1796=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28070,null,"See CPT",null,941.45400000000006,null,609.6869999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1830,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1830,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1830=1,IF(F1830=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28190,null,"See CPT",null,455.673,null,231.6,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1839,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1839,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1839=1,IF(F1839=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28225,null,"See CPT",null,752.69999999999993,null,458.56799999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1859,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1859,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1859=1,IF(F1859=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28292,null,"See CPT",null,1267.431,null,831.44399999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1876,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1876,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1876=1,IF(F1876=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28315,null,"See CPT",null,864.447,null,565.68299999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1888,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1888,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1888=1,IF(F1888=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28420,null,"See CPT",null,2256.9419999999996,null,2256.9419999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1919,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1919,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1919=1,IF(F1919=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28600,null,"See CPT",null,387.351,null,326.55599999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1935,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1935,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1935=1,IF(F1935=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28735,null,"See CPT",null,1347.912,null,1347.912,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1943,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1943,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1943=1,IF(F1943=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},28810,null,"See CPT",null,735.32999999999993,null,735.32999999999993,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1978,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1978,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1978=1,IF(F1978=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29425,null,"See CPT",null,132.01199999999997,null,93.798000000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E1985,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F1985,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A1985=1,IF(F1985=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29520,null,"See CPT",null,63.690000000000005,null,31.845000000000002,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2004,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2004,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2004=1,IF(F2004=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29807,null,"See CPT",null,1792.5840000000001,null,1792.5840000000001,null,"090",0.1,0.69,0.21,0,3,1,1,1,0,29805,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2032,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2032,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2032=1,IF(F2032=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29860,null,"See CPT",null,1120.365,null,1120.365,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2047,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2047,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2047=1,IF(F2047=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29880,null,"See CPT",null,980.82600000000002,null,980.82600000000002,null,"090",0.1,0.69,0.21,0,3,1,0,1,0,29870,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2057,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2057,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A2057=1,IF(F2057=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A2057=1,IF(F2057=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29891,null,"See CPT",null,1165.5269999999998,null,1165.5269999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2071,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2071,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2071=1,IF(F2071=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},29907,null,"See CPT",null,1522.1909999999998,null,1522.1909999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2104,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2104,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2104=1,IF(F2104=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},30465,null,"See CPT",null,1858.0110000000002,null,1858.0110000000002,null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2108,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2108,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2108=1,IF(F2108=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},30545,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2133,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2133,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2133=1,IF(F2133=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31075,null,"See CPT",null,1505.3999999999999,null,1505.3999999999999,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2151,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2151,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2151=1,IF(F2151=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31239,null,"See CPT",null,1058.412,null,1058.412,null,"010",0.1,0.8,0.1,0,3,1,0,0,0,31231,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2180,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2180,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2180=1,IF(F2180=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2194,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2194,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2194=1,IF(F2194=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31515,null,"See CPT",null,396.036,null,191.649,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2205,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2205,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2205=1,IF(F2205=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31540,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,31525,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2230,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2230,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2230=1,IF(F2230=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31592,null,"See CPT",null,3078.5430000000001,null,3078.5430000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2255,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2255,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2255=1,IF(F2255=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31635,null,"See CPT",null,522.83699999999999,null,300.50100000000003,null,"000",0,0,0,0,3,0,1,0,0,31622,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2273,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2273,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2273=1,IF(F2273=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31717,null,"See CPT",null,534.41700000000003,null,181.80600000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2279,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2279,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2279=1,IF(F2279=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},31760,null,"See CPT",null,2339.16,null,2339.16,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2302,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2302,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2302=1,IF(F2302=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},32140,null,"See CPT",null,1688.364,null,1688.364,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2322,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2322,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2322=1,IF(F2322=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},32488,null,"See CPT",null,4048.9470000000001,null,4048.9470000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2331,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2331,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2331=1,IF(F2331=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},32550,null,"See CPT",null,1523.9279999999999,null,349.137,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2359,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2359,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2359=1,IF(F2359=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},32663,null,"See CPT",null,2372.7419999999997,null,2372.7419999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2378,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2378,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2378=1,IF(F2378=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},32852,null,"See CPT",null,6050.55,null,6050.55,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2402,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2402,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2402=1,IF(F2402=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33130,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2407,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2407,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2407=1,IF(F2407=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33206,null,"See CPT",null,790.91399999999999,null,790.91399999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2426,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2426,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2426=1,IF(F2426=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33227,null,"See CPT",null,589.42200000000003,null,589.42200000000003,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2450,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2450,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2450=1,IF(F2450=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33261,null,"See CPT",null,2729.4059999999999,null,2729.4059999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2475,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2475,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2475=1,IF(F2475=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33362,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,2,1,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2487,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2487=1,IF(F2487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33406,null,"See CPT",null,4872.8639999999996,null,4872.8639999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2500,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2500,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2500=1,IF(F2500=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33425,null,"See CPT",null,4619.2619999999997,null,4619.2619999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2530,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2530,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2530=1,IF(F2530=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33513,null,"See CPT",null,4205.8559999999998,null,4205.8559999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2547,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2547,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2547=1,IF(F2547=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33572,null,"See CPT",null,387.351,null,387.351,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2554,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2554,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2554=1,IF(F2554=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33612,null,"See CPT",null,3385.413,null,3385.413,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2576,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2576,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2576=1,IF(F2576=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33697,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2591,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2591,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2591=1,IF(F2591=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33750,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2623,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2623,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2623=1,IF(F2623=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33852,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2634,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2634,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2634=1,IF(F2634=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33881,null,"See CPT",null,2577.1289999999999,null,2577.1289999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,2,2,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2648,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2648,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2648=1,IF(F2648=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33926,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2677,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2677,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2677=1,IF(F2677=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33968,null,"See CPT",null,56.741999999999997,null,56.741999999999997,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2695,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2695,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2695=1,IF(F2695=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33987,null,"See CPT",null,349.71600000000001,null,349.71600000000001,null,"000",0,0,0,0,0,0,0,1,1,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2702,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2702,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2702=1,IF(F2702=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},33995,null,"See CPT",null,617.79300000000001,null,617.79300000000001,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2719,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2719,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2719=1,IF(F2719=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},34510,null,"See CPT",null,1708.6290000000001,null,1708.6290000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2745,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2745,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2745=1,IF(F2745=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},34831,null,"See CPT",null,3212.2919999999999,null,3212.2919999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2762,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2762,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2762=1,IF(F2762=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35013,null,"See CPT",null,2123.7719999999999,null,2123.7719999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2774,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2774,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2774=1,IF(F2774=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35121,null,"See CPT",null,2636.7660000000001,null,2636.7660000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2805,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2805,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2805=1,IF(F2805=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35281,null,"See CPT",null,2718.4050000000002,null,2718.4050000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2821,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2821,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2821=1,IF(F2821=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35371,null,"See CPT",null,1372.23,null,1372.23,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2842,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2842,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2842=1,IF(F2842=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35533,null,"See CPT",null,2514.5969999999998,null,2514.5969999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2850,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2850,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2850=1,IF(F2850=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35558,null,"See CPT",null,2059.5030000000002,null,2059.5030000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2866,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2866,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2866=1,IF(F2866=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35621,null,"See CPT",null,1838.325,null,1838.325,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2893,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2893,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2893=1,IF(F2893=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35691,null,"See CPT",null,1582.4069999999999,null,1582.4069999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2909,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2909,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2909=1,IF(F2909=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},35879,null,"See CPT",null,1549.9829999999999,null,1549.9829999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2922,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2922,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2922=1,IF(F2922=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36012,null,"See CPT",null,1650.1499999999999,null,292.97399999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2947,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2947,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2947=1,IF(F2947=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36252,null,"See CPT",null,2807.5709999999999,null,607.37099999999998,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2970,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2970,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2970=1,IF(F2970=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36468,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2990,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2990,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2990=1,IF(F2990=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36555,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E2994,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F2994,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A2994=1,IF(F2994=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36560,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3019,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3019,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3019=1,IF(F3019=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36595,null,"See CPT",null,1163.211,null,308.60699999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3037,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3037,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3037=1,IF(F3037=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},36825,null,"See CPT",null,1345.5959999999998,null,1345.5959999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3066,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3066,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3066=1,IF(F3066=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},37188,null,"See CPT",null,3014.2739999999999,null,467.83199999999999,null,"000",0,0,0,0,0,1,1,2,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3074,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3074,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3074=1,IF(F3074=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},37212,null,"See CPT",null,567.99900000000002,null,567.99900000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3095,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3095,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3095=1,IF(F3095=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},37234,null,"See CPT",null,7497.4710000000005,null,481.149,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3117,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3117,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3117=1,IF(F3117=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},37607,null,"See CPT",null,638.05799999999999,null,638.05799999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3138,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3138,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3138=1,IF(F3138=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},37799,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3160,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3160,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3160=1,IF(F3160=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},38222,null,"See CPT",null,321.92399999999998,null,132.59100000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3167,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3167,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3167=1,IF(F3167=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},38300,null,"See CPT",null,621.846,null,365.928,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3192,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3192,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3192=1,IF(F3192=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},38724,null,"See CPT",null,2526.1770000000001,null,2526.1770000000001,null,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3202,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3202,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3202=1,IF(F3202=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},38792,null,"See CPT",null,148.803,null,55.583999999999996,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3217,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3217,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3217=1,IF(F3217=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},39545,null,"See CPT",null,1530.876,null,1530.876,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3245,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3245,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3245=1,IF(F3245=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},40814,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3264,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3264,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3264=1,IF(F3264=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},41010,null,"See CPT",null,417.459,null,198.018,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3282,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3282,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3282=1,IF(F3282=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},41140,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3293,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3293,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3293=1,IF(F3293=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},41530,null,"See CPT",null,1878.2759999999998,null,712.74900000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3325,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3325,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3325=1,IF(F3325=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},42210,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3340,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3340,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3340=1,IF(F3340=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},42330,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3349,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3349,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3349=1,IF(F3349=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},42420,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3365,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3365,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3365=1,IF(F3365=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},42700,null,"See CPT",null,357.822,null,241.44299999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3392,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3392,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3392=1,IF(F3392=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},42950,null,"See CPT",null,1483.3979999999999,null,1483.3979999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3412,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3412,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3412=1,IF(F3412=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43117,null,"See CPT",null,5524.8180000000002,null,5524.8180000000002,null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3419,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3419,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3419=1,IF(F3419=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43135,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3453,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3453,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3453=1,IF(F3453=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43238,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,3,0,1,0,0,43235,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3462,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3462,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3462=1,IF(F3462=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43247,null,"See CPT",null,706.38,null,301.65899999999999,null,"000",0,0,0,0,3,0,1,0,0,43235,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3477,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3477,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3477=1,IF(F3477=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43264,null,"See CPT",null,619.53,null,619.53,null,"000",0,0,0,0,3,0,1,0,0,43260,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3509,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3509,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3509=1,IF(F3509=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43331,null,"See CPT",null,2283.576,null,2283.576,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3514,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3514,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3514=1,IF(F3514=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43336,null,"See CPT",null,2465.3820000000001,null,2465.3820000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3538,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3538,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3538=1,IF(F3538=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43520,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3557,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3557,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3557=1,IF(F3557=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43652,null,"See CPT",null,1323.0150000000001,null,1323.0150000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3567,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3567,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3567=1,IF(F3567=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43762,null,"See CPT",null,441.77699999999999,null,63.111000000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3600,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3600,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3600=1,IF(F3600=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},43999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3610,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3610,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3610=1,IF(F3610=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44110,null,"See CPT",null,1461.396,null,1461.396,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3624,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3624,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3624=1,IF(F3624=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44139,null,"See CPT",null,204.38699999999997,null,204.38699999999997,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3657,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3657,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A3657=1,IF(F3657=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A3657=1,IF(F3657=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44310,null,"See CPT",null,1781.0040000000001,null,1781.0040000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3664,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3664,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3664=1,IF(F3664=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44345,null,"See CPT",null,1801.848,null,1801.848,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3685,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3685,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3685=1,IF(F3685=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44386,null,"See CPT",null,588.84299999999996,null,151.69800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3707,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3707,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3707=1,IF(F3707=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44625,null,"See CPT",null,1730.0519999999999,null,1730.0519999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3728,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3728,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3728=1,IF(F3728=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},44960,null,"See CPT",null,1508.2950000000001,null,1508.2950000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3736,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3736,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3736=1,IF(F3736=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},45110,null,"See CPT",null,3135.8639999999996,null,3135.8639999999996,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3765,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3765,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3765=1,IF(F3765=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},45327,null,"See CPT",null,199.755,null,199.755,null,"000",0,0,0,0,3,0,1,0,0,45300,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3783,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3783,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3783=1,IF(F3783=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},45379,null,"See CPT",null,793.2299999999999,null,406.45799999999997,null,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3789,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3789,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3789=1,IF(F3789=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},45386,null,"See CPT",null,1164.9480000000001,null,360.71700000000004,null,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3812,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3812,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3812=1,IF(F3812=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},45800,null,"See CPT",null,2196.7259999999997,null,2196.7259999999997,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3832,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3832,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3832=1,IF(F3832=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},46220,null,"See CPT",null,451.62,null,210.17699999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3855,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3855,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3855=1,IF(F3855=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},46608,null,"See CPT",null,551.78699999999992,null,144.17100000000002,null,"000",0,0,0,0,3,0,1,0,0,46600,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3875,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3875,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3875=1,IF(F3875=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},46748,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3884,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3884,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3884=1,IF(F3884=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3905,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3905,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3905=1,IF(F3905=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},47133,null,"See CPT",null,5035.1665478400009,null,5035.16654784,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3917,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3917,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3917=1,IF(F3917=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},47360,null,"See CPT",null,3230.241,null,3230.241,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3952,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3952,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3952=1,IF(F3952=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},47555,null,"See CPT",null,550.62900000000002,null,550.62900000000002,null,"000",0,0,0,0,3,0,1,0,0,47552,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3960,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3960,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3960=1,IF(F3960=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},47605,null,"See CPT",null,1939.6499999999999,null,1939.6499999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3981,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3981,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3981=1,IF(F3981=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},47999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,1,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E3997,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F3997,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A3997=1,IF(F3997=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},48155,null,"See CPT",null,3142.8119999999999,null,3142.8119999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4010,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4010,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4010=1,IF(F4010=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},48554,null,"See CPT",null,4477.4070000000002,null,4477.4070000000002,null,"090",0.09,0.81,0.1,0,2,0,2,2,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4040,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4040,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4040=1,IF(F4040=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},49327,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4057,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4057,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4057=1,IF(F4057=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},49427,null,"See CPT",null,64.847999999999999,null,64.847999999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4083,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4083,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4083=1,IF(F4083=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},49550,null,"See CPT",null,998.19599999999991,null,998.19599999999991,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4100,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4100,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4100=1,IF(F4100=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},49605,null,"See CPT",null,8401.8690000000006,null,8401.8690000000006,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4107,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4107,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4107=1,IF(F4107=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},49653,null,"See CPT",null,1606.146,null,1606.146,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4129,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4129,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4129=1,IF(F4129=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50120,null,"See CPT",null,1650.729,null,1650.729,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4144,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4144,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4144=1,IF(F4144=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50300,null,"See CPT",null,3876.5107180800001,null,3876.5107180800001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4158,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4158,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4158=1,IF(F4158=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50385,null,"See CPT",null,2054.2919999999999,null,373.45499999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4179,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4179,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4179=1,IF(F4179=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50540,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.08,0.83,0.09,0,2,2,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4211,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4211,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4211=1,IF(F4211=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50660,null,"See CPT",null,1983.075,null,1983.075,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4226,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4226,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4226=1,IF(F4226=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50728,null,"See CPT",null,1273.8,null,1273.8,null,"090",0.08,0.83,0.09,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4248,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4248,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4248=1,IF(F4248=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4255,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4255,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4255=1,IF(F4255=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},50957,null,"See CPT",null,764.28,null,608.529,null,"000",0,0,0,0,3,1,0,0,0,50951,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4272,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4272,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4272=1,IF(F4272=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},51102,null,"See CPT",null,441.19799999999998,null,250.12800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4298,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4298,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4298=1,IF(F4298=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},51715,null,"See CPT",null,668.16599999999994,null,345.66299999999995,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4315,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4315,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4315=1,IF(F4315=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},51736,null,"See CPT",null,23.738999999999997,null,23.738999999999997,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4327,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4327,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4327=1,IF(F4327=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},51792,null,"See CPT",null,504.88800000000003,null,504.88800000000003,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4358,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4358,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4358=1,IF(F4358=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},52224,null,"See CPT",null,1521.0329999999999,null,349.71600000000001,null,"000",0,0,0,0,3,0,1,0,0,52000,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4374,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4374,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4374=1,IF(F4374=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},52290,null,"See CPT",null,419.77499999999998,null,419.77499999999998,null,"000",0,0,0,0,3,2,1,0,0,52000,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4395,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4395,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4395=1,IF(F4395=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},52352,null,"See CPT",null,608.529,null,608.529,null,"000",0,0,0,0,3,1,1,0,0,52351,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4403,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4403,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4403=1,IF(F4403=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},52442,null,"See CPT",null,1891.5930000000001,null,86.85,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4424,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4424,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4424=1,IF(F4424=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},53220,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4443,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4443,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4443=1,IF(F4443=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},53444,null,"See CPT",null,1382.0730000000001,null,1382.0730000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4453,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4453,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4453=1,IF(F4453=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},53505,null,"See CPT",null,851.12999999999988,null,851.12999999999988,null,"090",0.08,0.83,0.09,0,2,0,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4480,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4480,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4480=1,IF(F4480=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},54105,null,"See CPT",null,496.20300000000003,null,371.71799999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4500,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4500,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4500=1,IF(F4500=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},54235,null,"See CPT",null,157.488,null,126.80099999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4523,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4523,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4523=1,IF(F4523=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},54360,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4543,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4543,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4543=1,IF(F4543=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},54450,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4547,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4547,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4547=1,IF(F4547=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},54520,null,"See CPT",null,575.52599999999995,null,575.52599999999995,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4572,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4572,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4572=1,IF(F4572=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},55000,null,"See CPT",null,217.125,null,146.48699999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4590,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4590,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4590=1,IF(F4590=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},55540,null,"See CPT",null,961.1400000000001,null,961.1400000000001,null,"090",0.1,0.8,0.1,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4601,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4601,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4601=1,IF(F4601=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},55725,null,"See CPT",null,1042.779,null,1042.779,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4627,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4627,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4627=1,IF(F4627=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},56440,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4648,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4648,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4648=1,IF(F4648=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},56820,null,"See CPT",null,221.75700000000001,null,147.066,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4669,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4669,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4669=1,IF(F4669=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},57156,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4675,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4675,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4675=1,IF(F4675=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},57220,null,"See CPT",null,612.00300000000004,null,612.00300000000004,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4698,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4698,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4698=1,IF(F4698=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},57307,null,"See CPT",null,1850.4839999999999,null,1850.4839999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4712,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4712,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4712=1,IF(F4712=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},57426,null,"See CPT",null,1531.4549999999999,null,1531.4549999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4745,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4745,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A4745=1,IF(F4745=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A4745=1,IF(F4745=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},58152,null,"See CPT",null,2175.3029999999999,null,2175.3029999999999,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4755,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4755,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4755=1,IF(F4755=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},58275,null,"See CPT",null,1742.79,null,1742.79,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4770,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4770,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4770=1,IF(F4770=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},58350,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4798,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4798,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4798=1,IF(F4798=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},58572,null,"See CPT",null,1815.165,null,1815.165,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4817,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4817,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4817=1,IF(F4817=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},58720,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4822,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4822,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4822=1,IF(F4822=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},58770,null,"See CPT",null,1518.7170000000001,null,1518.7170000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4846,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4846,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4846=1,IF(F4846=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},59000,null,"See CPT",null,213.072,null,137.22300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4859,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4859,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4859=1,IF(F4859=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},59070,null,"See CPT",null,713.32799999999997,null,530.94299999999998,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4893,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4893,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4893=1,IF(F4893=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},59618,null,"See CPT",null,4651.6859999999997,null,4651.6859999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4896,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4896,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4896=1,IF(F4896=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},59812,null,"See CPT",null,636.32100000000003,null,537.89099999999996,null,"090",0.17,0.6,0.23,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4920,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4920,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4920=1,IF(F4920=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},60225,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4943,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4943,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4943=1,IF(F4943=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},60699,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4963,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4963,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4963=1,IF(F4963=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61253,null,"See CPT",null,1706.3129999999999,null,1706.3129999999999,null,"090",0.11,0.76,0.13,0,2,2,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E4972,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F4972,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A4972=1,IF(F4972=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61321,null,"See CPT",null,3626.277,null,3626.277,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5006,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5006,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5006=1,IF(F5006=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61540,null,"See CPT",null,3714.2850000000003,null,3714.2850000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5015,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5015,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5015=1,IF(F5015=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61556,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5030,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5030,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5030=1,IF(F5030=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61583,null,"See CPT",null,5079.567,null,5079.567,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5044,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5044,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5044=1,IF(F5044=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61606,null,"See CPT",null,5088.8310000000001,null,5088.8310000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5073,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5073,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5073=1,IF(F5073=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61702,null,"See CPT",null,6816.567,null,6816.567,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5091,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5091,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5091=1,IF(F5091=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},61797,null,"See CPT",null,369.98099999999999,null,369.98099999999999,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5110,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5110,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5110=1,IF(F5110=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},62117,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5120,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5120,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5120=1,IF(F5120=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},62148,null,"See CPT",null,211.33499999999998,null,211.33499999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5141,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5141,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5141=1,IF(F5141=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},62263,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5171,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5171,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5171=1,IF(F5171=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},62329,null,"See CPT",null,592.89599999999996,null,189.91199999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5188,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5188,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5188=1,IF(F5188=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63012,null,"See CPT",null,2051.3969999999999,null,2051.3969999999999,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5195,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5195,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5195=1,IF(F5195=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63040,null,"See CPT",null,2384.3220000000001,null,2384.3220000000001,null,"090",0.11,0.76,0.13,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5217,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5217,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5217=1,IF(F5217=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63086,null,"See CPT",null,320.76600000000002,null,320.76600000000002,null,"000",0,0,0,0,0,0,2,2,2,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5238,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5238,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5238=1,IF(F5238=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63250,null,"See CPT",null,5039.0370000000003,null,5039.0370000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5260,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5260,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5260=1,IF(F5260=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63290,null,"See CPT",null,4747.2209999999995,null,4747.2209999999995,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5281,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5281,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5281=1,IF(F5281=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63685,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5289,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5289,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5289=1,IF(F5289=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},63710,null,"See CPT",null,1869.0119999999999,null,1869.0119999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5318,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5318,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5318=1,IF(F5318=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64479,null,"See CPT",null,486.36,null,226.38900000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5336,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5336,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5336=1,IF(F5336=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64530,null,"See CPT",null,427.88099999999997,null,163.27799999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5342,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5342,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5342=1,IF(F5342=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64569,null,"See CPT",null,1317.8040000000001,null,1317.8040000000001,null,"090",0.11,0.76,0.13,0,2,1,0,1,1,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5365,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5365,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5365=1,IF(F5365=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64635,null,"See CPT",null,767.75400000000002,null,386.19299999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5386,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5386,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5386=1,IF(F5386=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64719,null,"See CPT",null,709.27499999999998,null,709.27499999999998,null,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5403,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5403,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5403=1,IF(F5403=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64771,null,"See CPT",null,1049.7269999999999,null,1049.7269999999999,null,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5415,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5415,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5415=1,IF(F5415=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64792,null,"See CPT",null,1841.799,null,1841.799,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5446,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5446,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5446=1,IF(F5446=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64886,null,"See CPT",null,2226.2550000000001,null,2226.2550000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5462,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5462,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5462=1,IF(F5462=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},64913,null,"See CPT",null,301.65899999999999,null,301.65899999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5470,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5470,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5470=1,IF(F5470=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},65112,null,"See CPT",null,2602.605,null,2602.605,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5487,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5487=1,IF(F5487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},65272,null,"See CPT",null,943.77,null,607.37099999999998,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5513,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5513,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A5513=1,IF(F5513=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A5513=1,IF(F5513=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},65771,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5534,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5534,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5534=1,IF(F5534=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},65920,null,"See CPT",null,1363.5450000000001,null,1363.5450000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5550,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5550,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5550=1,IF(F5550=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},66185,null,"See CPT",null,1461.9749999999999,null,1461.9749999999999,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5563,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5563,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5563=1,IF(F5563=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},66710,null,"See CPT",null,771.22799999999995,null,670.48199999999997,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5593,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5593,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5593=1,IF(F5593=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},67027,null,"See CPT",null,1450.9739999999999,null,1450.9739999999999,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5610,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5610,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5610=1,IF(F5610=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},67120,null,"See CPT",null,1177.107,null,952.45499999999993,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5631,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5631,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5631=1,IF(F5631=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},67320,null,"See CPT",null,532.67999999999995,null,532.67999999999995,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5635,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5635,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5635=1,IF(F5635=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},67335,null,"See CPT",null,245.49600000000001,null,245.49600000000001,null,"000",0,0,0,0,0,1,1,1,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5660,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5660,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5660=1,IF(F5660=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},67710,null,"See CPT",null,453.35699999999997,null,169.06799999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5678,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5678,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5678=1,IF(F5678=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},67902,null,"See CPT",null,1243.692,null,1243.692,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5707,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5707,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5707=1,IF(F5707=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},68100,null,"See CPT",null,326.55599999999998,null,162.69900000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5721,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5721,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5721=1,IF(F5721=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},68362,null,"See CPT",null,1121.5230000000001,null,1121.5230000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5732,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5732,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5732=1,IF(F5732=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},68530,null,"See CPT",null,788.01899999999989,null,431.93399999999997,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5745,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5745,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5745=1,IF(F5745=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},68811,null,"See CPT",null,231.02100000000002,null,231.02100000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5779,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5779,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5779=1,IF(F5779=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},69450,null,"See CPT",null,1020.198,null,1020.198,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5782,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5782,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5782=1,IF(F5782=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},69505,null,"See CPT",null,2266.7849999999999,null,2266.7849999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5808,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5808,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5808=1,IF(F5808=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},69650,null,"See CPT",null,1476.45,null,1476.45,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5825,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5825,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5825=1,IF(F5825=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},69720,null,"See CPT",null,2166.6179999999999,null,2166.6179999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,1,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5855,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5855,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A5855=1,IF(F5855=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70110,"TC","See CPT",null,57.9,null,57.9,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5858,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5858,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A5858=1,IF(F5858=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70120,"TC","See CPT",null,53.847000000000001,null,53.847000000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5886,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5886,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A5886=1,IF(F5886=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70210,26,"See CPT",null,14.475,null,14.475,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5905,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5905,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5905=1,IF(F5905=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70320,null,"See CPT",null,101.325,null,101.325,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5929,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5929,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5929=1,IF(F5929=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70370,null,"See CPT",null,176.01599999999999,null,176.01599999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5930,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5930,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A5930=1,IF(F5930=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70370,"TC","See CPT",null,151.119,null,151.119,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5953,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5953,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5953=1,IF(F5953=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70481,null,"See CPT",null,353.19,null,353.19,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5977,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5977,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A5977=1,IF(F5977=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70496,null,"See CPT",null,532.101,null,532.101,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E5996,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F5996,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A5996=1,IF(F5996=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70545,"TC","See CPT",null,356.08500000000004,null,356.08500000000004,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6006,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6006,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6006=1,IF(F6006=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70548,26,"See CPT",null,123.32699999999998,null,123.32699999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6033,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6033,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6033=1,IF(F6033=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},70559,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6053,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6053,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6053=1,IF(F6053=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},71110,"TC","See CPT",null,54.425999999999995,null,54.425999999999995,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6076,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6076,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6076=1,IF(F6076=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},71275,null,"See CPT",null,543.68100000000004,null,543.68100000000004,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6082,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6082,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6082=1,IF(F6082=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},71551,null,"See CPT",null,774.12299999999993,null,774.12299999999993,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6103,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6103,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6103=1,IF(F6103=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72070,null,"See CPT",null,58.478999999999999,null,58.478999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6118,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6118,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6118=1,IF(F6118=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72082,null,"See CPT",null,126.80099999999999,null,126.80099999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6150,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6150,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6150=1,IF(F6150=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72128,26,"See CPT",null,82.217999999999989,null,82.217999999999989,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6161,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6161,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6161=1,IF(F6161=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72132,"TC","See CPT",null,226.96799999999999,null,226.96799999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6175,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6175,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6175=1,IF(F6175=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72147,null,"See CPT",null,550.62900000000002,null,550.62900000000002,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6204,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6204,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6204=1,IF(F6204=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72191,26,"See CPT",null,147.64499999999998,null,147.64499999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6222,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6222,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6222=1,IF(F6222=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72197,26,"See CPT",null,180.648,null,180.648,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6228,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6228,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6228=1,IF(F6228=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72200,26,"See CPT",null,13.895999999999999,null,13.895999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6251,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6251,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6251=1,IF(F6251=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},72285,"TC","See CPT",null,128.53800000000001,null,128.53800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6265,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6265,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6265=1,IF(F6265=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73030,null,"See CPT",null,61.374000000000002,null,61.374000000000002,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6298,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6298,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6298=1,IF(F6298=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73115,null,"See CPT",null,248.96999999999997,null,248.96999999999997,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6308,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6308,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6308=1,IF(F6308=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73140,"TC","See CPT",null,55.583999999999996,null,55.583999999999996,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6327,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6327,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6327=1,IF(F6327=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73219,26,"See CPT",null,133.749,null,133.749,null,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6348,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6348,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6348=1,IF(F6348=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73502,26,"See CPT",null,19.106999999999999,null,19.106999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6369,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6369,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6369=1,IF(F6369=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73552,26,"See CPT",null,15.054,null,15.054,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6377,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6377,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6377=1,IF(F6377=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73564,"TC","See CPT",null,63.690000000000005,null,63.690000000000005,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6393,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6393,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6393=1,IF(F6393=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73600,26,"See CPT",null,13.317,null,13.317,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6420,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6420,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6420=1,IF(F6420=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73702,26,"See CPT",null,100.167,null,100.167,null,"000",0,0,0,1,9,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6436,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6436,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6436=1,IF(F6436=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},73722,null,"See CPT",null,648.4799999999999,null,648.4799999999999,null,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6449,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6449,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6449=1,IF(F6449=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74019,"TC","See CPT",null,46.899000000000001,null,46.899000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6479,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6479,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6479=1,IF(F6479=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74178,"TC","See CPT",null,508.36199999999997,null,508.36199999999997,null,"000",0,0,0,1,9,0,9,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6496,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6496,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6496=1,IF(F6496=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74210,null,"See CPT",null,178.33199999999999,null,178.33199999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6516,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6516,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6516=1,IF(F6516=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74246,26,"See CPT",null,73.533000000000001,null,73.533000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6525,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6525,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6525=1,IF(F6525=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74251,26,"See CPT",null,96.692999999999998,null,96.692999999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6540,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6540,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6540=1,IF(F6540=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74280,26,"See CPT",null,104.22,null,104.22,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6568,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6568,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6568=1,IF(F6568=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74360,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6593,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6593,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6593=1,IF(F6593=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74440,"TC","See CPT",null,154.01400000000001,null,154.01400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6601,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6601,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A6601=1,IF(F6601=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A6601=1,IF(F6601=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74455,null,"See CPT",null,196.85999999999999,null,196.85999999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6622,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6622,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6622=1,IF(F6622=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},74742,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6644,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6644,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6644=1,IF(F6644=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75571,"TC","See CPT",null,142.434,null,142.434,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6665,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6665,1)","v":1},{"$f":"IF(A6665=1,IF(F6665=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A6665=1,IF(F6665=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75635,26,"See CPT",null,195.12299999999999,null,195.12299999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6668,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6668,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6668=1,IF(F6668=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75705,26,"See CPT",null,194.54399999999998,null,194.54399999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6694,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6694,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6694=1,IF(F6694=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75746,"TC","See CPT",null,159.80399999999997,null,159.80399999999997,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6711,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6711,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6711=1,IF(F6711=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75807,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,2,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6741,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6741,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6741=1,IF(F6741=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75842,null,"See CPT",null,294.13200000000001,null,294.13200000000001,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6748,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6748,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6748=1,IF(F6748=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75870,"TC","See CPT",null,205.54499999999999,null,205.54499999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6770,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6770,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6770=1,IF(F6770=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75893,26,"See CPT",null,43.424999999999997,null,43.424999999999997,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6791,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6791,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6791=1,IF(F6791=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},75958,26,"See CPT",null,320.18700000000001,null,320.18700000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6813,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6813,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6813=1,IF(F6813=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76098,null,"See CPT",null,74.691000000000003,null,74.691000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6820,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6820,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6820=1,IF(F6820=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76101,"TC","See CPT",null,139.53900000000002,null,139.53900000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6852,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6852,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6852=1,IF(F6852=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76497,26,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6867,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6867,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6867=1,IF(F6867=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76511,26,"See CPT",null,60.795000000000002,null,60.795000000000002,null,"000",0,0,0,1,9,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6876,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6876,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6876=1,IF(F6876=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76514,26,"See CPT",null,13.317,null,13.317,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6892,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6892,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6892=1,IF(F6892=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76604,26,"See CPT",null,47.477999999999994,null,47.477999999999994,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6919,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6919,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6919=1,IF(F6919=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76800,26,"See CPT",null,99.587999999999994,null,99.587999999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6939,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6939,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6939=1,IF(F6939=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76813,"TC","See CPT",null,122.748,null,122.748,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6956,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6956,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6956=1,IF(F6956=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76819,null,"See CPT",null,156.33000000000001,null,156.33000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6968,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6968,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A6968=1,IF(F6968=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76826,null,"See CPT",null,305.13299999999998,null,305.13299999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E6999,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F6999,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A6999=1,IF(F6999=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76881,"TC","See CPT",null,64.269000000000005,null,64.269000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7015,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7015,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7015=1,IF(F7015=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76936,26,"See CPT",null,161.541,null,161.541,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7023,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7023,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7023=1,IF(F7023=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76941,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7040,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7040,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7040=1,IF(F7040=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76975,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7065,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7065,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7065=1,IF(F7065=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},76999,26,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7084,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7084,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7084=1,IF(F7084=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77013,26,"See CPT",null,313.23899999999998,null,313.23899999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7094,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7094,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7094=1,IF(F7094=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77046,null,"See CPT",null,429.61799999999999,null,429.61799999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7127,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7127,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7127=1,IF(F7127=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77067,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,2,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7137,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7137,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7137=1,IF(F7137=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77074,null,"See CPT",null,116.958,null,116.958,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7151,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7151,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7151=1,IF(F7151=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77078,26,"See CPT",null,20.843999999999998,null,20.843999999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7184,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7184,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7184=1,IF(F7184=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77295,26,"See CPT",null,379.82399999999996,null,379.82399999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7188,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7188,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7188=1,IF(F7188=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77300,null,"See CPT",null,116.958,null,116.958,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7213,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7213,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7213=1,IF(F7213=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77331,26,"See CPT",null,77.007000000000005,null,77.007000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7231,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7231,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7231=1,IF(F7231=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77373,null,"See CPT",null,2102.9279999999999,null,2102.9279999999999,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7242,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7242,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7242=1,IF(F7242=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77417,null,"See CPT",null,20.843999999999998,null,20.843999999999998,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7274,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7274,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7274=1,IF(F7274=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77620,"TC","See CPT",null,1041.6209999999999,null,1041.6209999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7285,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7285,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7285=1,IF(F7285=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77763,null,"See CPT",null,1325.9099999999999,null,1325.9099999999999,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7298,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7298,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7298=1,IF(F7298=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},77771,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7332,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7332,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7332=1,IF(F7332=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78018,26,"See CPT",null,67.742999999999995,null,67.742999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7339,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7339,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7339=1,IF(F7339=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78071,null,"See CPT",null,642.68999999999994,null,642.68999999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7359,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7359,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7359=1,IF(F7359=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78104,26,"See CPT",null,63.690000000000005,null,63.690000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7382,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7382,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7382=1,IF(F7382=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78185,"TC","See CPT",null,286.60500000000002,null,286.60500000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7402,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7402,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7402=1,IF(F7402=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78216,null,"See CPT",null,233.916,null,233.916,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7411,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7411,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7411=1,IF(F7411=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78230,null,"See CPT",null,319.60799999999995,null,319.60799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7439,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7439,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7439=1,IF(F7439=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78268,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7458,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7458,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7458=1,IF(F7458=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78305,null,"See CPT",null,508.36199999999997,null,508.36199999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7463,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7463,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7463=1,IF(F7463=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78306,26,"See CPT",null,68.900999999999996,null,68.900999999999996,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7487,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7487=1,IF(F7487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78431,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7506,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7506,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7506=1,IF(F7506=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78452,26,"See CPT",null,133.16999999999999,null,133.16999999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7530,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7530,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7530=1,IF(F7530=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78468,26,"See CPT",null,65.426999999999992,null,65.426999999999992,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7549,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7549,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7549=1,IF(F7549=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78492,null,"See CPT",null,3159.9542145600003,null,3159.9542145599999,null,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7559,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7559,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7559=1,IF(F7559=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78499,26,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7580,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7580,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7580=1,IF(F7580=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78600,"TC","See CPT",null,298.76400000000001,null,298.76400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7591,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7591,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7591=1,IF(F7591=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7627,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7627,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7627=1,IF(F7627=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78708,null,"See CPT",null,317.29200000000003,null,317.29200000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7634,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7634,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7634=1,IF(F7634=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78725,"TC","See CPT",null,175.43699999999998,null,175.43699999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7656,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7656,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7656=1,IF(F7656=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78802,26,"See CPT",null,63.690000000000005,null,63.690000000000005,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7671,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7671,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7671=1,IF(F7671=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78813,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7685,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7685,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7685=1,IF(F7685=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},78831,null,"See CPT",null,1300.434,null,1300.434,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7714,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7714,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A7714=1,IF(F7714=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},79440,"TC","See CPT",null,75.27,null,75.27,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7732,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7732,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7732=1,IF(F7732=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80143,null,"See CPT",null,26.468799999999998,null,26.468799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7757,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7757,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7757=1,IF(F7757=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80180,null,"See CPT",null,25.631,null,25.631,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7775,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7775,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7775=1,IF(F7775=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80201,null,"See CPT",null,16.926399999999997,null,16.926399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7781,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7781,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7781=1,IF(F7781=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80235,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7804,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7804,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7804=1,IF(F7804=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80337,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7825,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7825,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7825=1,IF(F7825=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80358,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7842,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7842,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7842=1,IF(F7842=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80375,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7854,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7854,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7854=1,IF(F7854=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},80417,null,"See CPT",null,62.465800000000002,null,62.465800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7885,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7885,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7885=1,IF(F7885=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81109,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7901,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7901,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7901=1,IF(F7901=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81172,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7922,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7922,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7922=1,IF(F7922=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81193,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7930,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7930,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7930=1,IF(F7930=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81206,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7946,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7946,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7946=1,IF(F7946=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81225,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7977,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7977,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7977=1,IF(F7977=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81256,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E7989,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F7989,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A7989=1,IF(F7989=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81268,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8002,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8002,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8002=1,IF(F8002=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81284,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8032,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8032,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8032=1,IF(F8032=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81314,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8049,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8049,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8049=1,IF(F8049=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81331,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8070,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8070,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8070=1,IF(F8070=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81353,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8074,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8074,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8074=1,IF(F8074=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81361,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8099,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8099,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8099=1,IF(F8099=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81407,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8117,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8117,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8117=1,IF(F8117=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81432,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8128,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8128,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8128=1,IF(F8128=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81445,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8154,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8154,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8154=1,IF(F8154=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},81521,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8175,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8175,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8175=1,IF(F8175=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82013,null,"See CPT",null,17.451799999999999,null,17.451799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8197,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8197,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8197=1,IF(F8197=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82128,null,"See CPT",null,19.695399999999999,null,19.695399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8218,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8218,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8218=1,IF(F8218=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82248,null,"See CPT",null,7.1283999999999992,null,7.1283999999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8221,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8221,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8221=1,IF(F8221=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82270,null,"See CPT",null,6.2195999999999998,null,6.2195999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8247,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8247,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8247=1,IF(F8247=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82387,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8264,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8264,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8264=1,IF(F8264=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82530,null,"See CPT",null,23.728200000000001,null,23.728200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8276,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8276,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8276=1,IF(F8276=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82595,null,"See CPT",null,9.1873999999999985,null,9.1873999999999985,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8297,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8297,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8297=1,IF(F8297=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82677,null,"See CPT",null,34.335599999999999,null,34.335599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8325,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8325,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8325=1,IF(F8325=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82820,null,"See CPT",null,18.942799999999998,null,18.942799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8344,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8344,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8344=1,IF(F8344=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},82979,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8349,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8349,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8349=1,IF(F8349=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},83006,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8373,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8373,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8373=1,IF(F8373=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},83080,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8386,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8386,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8386=1,IF(F8386=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},83525,null,"See CPT",null,16.230599999999999,null,16.230599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8420,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8420,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8420=1,IF(F8420=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},83775,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8429,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8429,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8429=1,IF(F8429=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},83873,null,"See CPT",null,24.423999999999999,null,24.423999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8445,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8445,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8445=1,IF(F8445=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},83951,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8472,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8472,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8472=1,IF(F8472=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84138,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8492,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8492,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8492=1,IF(F8492=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84181,null,"See CPT",null,24.182600000000001,null,24.182600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8496,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8496,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8496=1,IF(F8496=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84203,null,"See CPT",null,13.8308,null,13.8308,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8521,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8521,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A8521=1,IF(F8521=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A8521=1,IF(F8521=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84376,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8542,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8542,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8542=1,IF(F8542=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84460,null,"See CPT",null,7.5259999999999998,null,7.5259999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8557,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8557,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8557=1,IF(F8557=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84540,null,"See CPT",null,7.8951999999999991,null,7.8951999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8571,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8571,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8571=1,IF(F8571=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},84600,null,"See CPT",null,24.296199999999999,null,24.296199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8594,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8594,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8594=1,IF(F8594=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},85046,null,"See CPT",null,7.9093999999999998,null,7.9093999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8618,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8618,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8618=1,IF(F8618=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},85293,null,"See CPT",null,26.880599999999998,null,26.880599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8637,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8637,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8637=1,IF(F8637=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},85380,null,"See CPT",null,14.455599999999999,null,14.455599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8647,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8647,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8647=1,IF(F8647=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},85420,null,"See CPT",null,9.2726000000000006,null,9.2726000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8680,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8680,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8680=1,IF(F8680=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},85810,null,"See CPT",null,16.571400000000001,null,16.571400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8690,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8690,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8690=1,IF(F8690=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86038,null,"See CPT",null,17.1678,null,17.1678,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8704,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8704,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8704=1,IF(F8704=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86155,null,"See CPT",null,22.7058,null,22.7058,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8719,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8719,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8719=1,IF(F8719=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86256,null,"See CPT",null,17.111000000000001,null,17.111000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8747,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8747,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8747=1,IF(F8747=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86336,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8766,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8766,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8766=1,IF(F8766=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86403,null,"See CPT",null,16.386799999999997,null,16.386799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8787,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8787,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8787=1,IF(F8787=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86611,null,"See CPT",null,14.455599999999999,null,14.455599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8808,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8808,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8808=1,IF(F8808=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86658,null,"See CPT",null,18.502599999999997,null,18.502599999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8816,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8816,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8816=1,IF(F8816=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86677,null,"See CPT",null,23.927,null,23.927,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8845,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8845,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8845=1,IF(F8845=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86738,null,"See CPT",null,18.800799999999999,null,18.800799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8863,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8863,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8863=1,IF(F8863=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86784,null,"See CPT",null,17.8352,null,17.8352,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8869,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8869,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8869=1,IF(F8869=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86794,null,"See CPT",null,23.927,null,23.927,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8892,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8892,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8892=1,IF(F8892=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86849,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8912,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8912,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8912=1,IF(F8912=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},86923,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8935,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8935,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8935=1,IF(F8935=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87045,null,"See CPT",null,13.404799999999998,null,13.404799999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8955,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8955,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8955=1,IF(F8955=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87118,null,"See CPT",null,20.746199999999998,null,20.746199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8964,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8964,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A8964=1,IF(F8964=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87164,26,"See CPT",null,33.002999999999993,null,33.002999999999993,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E8979,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F8979,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A8979=1,IF(F8979=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87197,null,"See CPT",null,21.328399999999998,null,21.328399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9011,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9011,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9011=1,IF(F9011=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87299,null,"See CPT",null,22.862000000000002,null,22.862000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9014,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9014,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9014=1,IF(F9014=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87305,null,"See CPT",null,17.011600000000001,null,17.011600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9040,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9040,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9040=1,IF(F9040=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87430,null,"See CPT",null,23.870199999999997,null,23.870199999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9061,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9061,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9061=1,IF(F9061=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87498,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9077,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9077,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9077=1,IF(F9077=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87525,null,"See CPT",null,42.315999999999995,null,42.315999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9090,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9090,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9090=1,IF(F9090=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87538,null,"See CPT",null,49.827800000000003,null,49.827800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9120,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9120,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9120=1,IF(F9120=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87637,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9137,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9137,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9137=1,IF(F9137=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87804,null,"See CPT",null,23.501000000000001,null,23.501000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9144,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9144,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9144=1,IF(F9144=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},87850,null,"See CPT",null,34.8752,null,34.8752,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9162,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9162,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9162=1,IF(F9162=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88016,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9187,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9187,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9187=1,IF(F9187=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88120,26,"See CPT",null,98.429999999999993,null,98.429999999999993,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9209,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9209,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9209=1,IF(F9209=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88161,"TC","See CPT",null,83.375999999999991,null,83.375999999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9224,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9224,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9224=1,IF(F9224=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88174,null,"See CPT",null,36.025399999999998,null,36.025399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9238,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9238,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9238=1,IF(F9238=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88199,26,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9259,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9259,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9259=1,IF(F9259=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88274,null,"See CPT",null,60.179600000000001,null,60.179600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9272,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9272,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9272=1,IF(F9272=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88302,26,"See CPT",null,11.58,null,11.58,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9306,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9306,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9306=1,IF(F9306=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88331,null,"See CPT",null,181.22699999999998,null,181.22699999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9309,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9309,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9309=1,IF(F9309=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88332,null,"See CPT",null,95.534999999999997,null,95.534999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9335,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9335,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9335=1,IF(F9335=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88355,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9352,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9352,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9352=1,IF(F9352=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88363,null,"See CPT",null,39.950999999999993,null,33.002999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9364,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9364,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9364=1,IF(F9364=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88367,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9395,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9395,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9395=1,IF(F9395=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},88388,26,"See CPT",null,40.529999999999994,null,40.529999999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9407,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9407,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9407=1,IF(F9407=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},89051,null,"See CPT",null,7.9519999999999991,null,7.9519999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9419,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9419,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9419=1,IF(F9419=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},89253,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9454,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9454,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9454=1,IF(F9454=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90281,null,"See CPT",null,24.8,null,24.8,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9456,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9456,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9456=1,IF(F9456=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90284,null,"See CPT",null,8.2100000000000009,null,8.2100000000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9483,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9483,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9483=1,IF(F9483=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90586,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9504,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9504,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9504=1,IF(F9504=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90661,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9523,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9523,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9523=1,IF(F9523=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90690,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9533,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9533,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9533=1,IF(F9533=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90714,null,"See CPT",null,25.1,null,25.1,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9560,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9560,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9560=1,IF(F9560=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90838,null,"See CPT",null,201.49199999999999,null,179.49,null,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9580,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9580,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9580=1,IF(F9580=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90889,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9603,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9603,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9603=1,IF(F9603=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90964,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9605,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9605,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9605=1,IF(F9605=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},90966,null,"See CPT",null,507.78299999999996,null,507.78299999999996,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9627,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9627,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9627=1,IF(F9627=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},91030,"TC","See CPT",null,187.017,null,187.017,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9652,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9652,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9652=1,IF(F9652=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},91111,26,"See CPT",null,87.429000000000002,null,87.429000000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9670,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9670,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9670=1,IF(F9670=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},91299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9681,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9681,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9681=1,IF(F9681=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92014,null,"See CPT",null,221.178,null,130.85399999999998,null,"000",0,0,0,0,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9707,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9707,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9707=1,IF(F9707=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92132,null,"See CPT",null,55.583999999999996,null,55.583999999999996,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9728,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9728,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9728=1,IF(F9728=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92229,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,9,2,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9749,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9749,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9749=1,IF(F9749=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92273,null,"See CPT",null,234.49499999999998,null,234.49499999999998,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9755,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9755,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9755=1,IF(F9755=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92284,"TC","See CPT",null,85.113,null,85.113,null,"000",0,0,0,1,9,2,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9778,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9778,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9778=1,IF(F9778=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92353,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9792,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9792,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9792=1,IF(F9792=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92512,null,"See CPT",null,110.00999999999999,null,47.477999999999994,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9807,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9807,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9807=1,IF(F9807=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92537,null,"See CPT",null,73.533000000000001,null,73.533000000000001,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9835,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9835,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9835=1,IF(F9835=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92549,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9850,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9850,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9850=1,IF(F9850=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92563,null,"See CPT",null,57.9,null,57.9,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9878,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9878,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9878=1,IF(F9878=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92597,null,"See CPT",null,124.48499999999999,null,124.48499999999999,null,"000",0,0,0,9,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9897,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9897,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9897=1,IF(F9897=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92620,null,"See CPT",null,162.11999999999998,null,139.53900000000002,null,"000",0,0,0,9,0,2,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9902,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9902,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9902=1,IF(F9902=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92630,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9926,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9926,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9926=1,IF(F9926=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92961,null,"See CPT",null,420.35399999999998,null,420.35399999999998,null,"000",0,0,0,0,9,9,9,9,9,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9939,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9939,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A9939=1,IF(F9939=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},92986,null,"See CPT",null,2260.4159999999997,null,2260.4159999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9955,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9955,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9955=1,IF(F9955=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93025,"TC","See CPT",null,182.964,null,182.964,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E9976,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F9976,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A9976=1,IF(F9976=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93260,26,"See CPT",null,72.953999999999994,null,72.953999999999994,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10006,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10006,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10006=1,IF(F10006=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93284,"TC","See CPT",null,81.059999999999988,null,81.059999999999988,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10023,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10023,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10023=1,IF(F10023=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93290,"TC","See CPT",null,57.9,null,57.9,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10043,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10043,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10043=1,IF(F10043=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93304,"TC","See CPT",null,238.548,null,238.548,null,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10052,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10052,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10052=1,IF(F10052=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93308,"TC","See CPT",null,141.85500000000002,null,141.85500000000002,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10067,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10067,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10067=1,IF(F10067=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93317,26,"See CPT",null,154.59299999999999,null,154.59299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10095,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10095,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10095=1,IF(F10095=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93453,null,"See CPT",null,2248.2570000000001,null,2248.2570000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10110,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10110,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10110=1,IF(F10110=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93458,null,"See CPT",null,2039.8169999999998,null,2039.8169999999998,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10124,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10124,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10124=1,IF(F10124=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93464,null,"See CPT",null,434.25,null,434.25,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10153,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10153,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10153=1,IF(F10153=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93567,null,"See CPT",null,215.96699999999998,null,88.587000000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10171,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10171,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10171=1,IF(F10171=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10190,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10190,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10190=1,IF(F10190=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10200,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10200,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10200=1,IF(F10200=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93620,"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10214,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10214,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10214=1,IF(F10214=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93631,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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10243,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10243,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10243=1,IF(F10243=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93702,null,"See CPT",null,270.39299999999997,null,270.39299999999997,null,"000",0,0,0,3,9,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10250,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10250,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10250=1,IF(F10250=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93745,"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10275,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10275,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10275=1,IF(F10275=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93888,26,"See CPT",null,43.424999999999997,null,43.424999999999997,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10297,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10297,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10297=1,IF(F10297=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93925,null,"See CPT",null,466.09500000000003,null,466.09500000000003,null,"000",0,0,0,1,9,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10318,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10318,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10318=1,IF(F10318=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93976,null,"See CPT",null,297.02699999999999,null,297.02699999999999,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10340,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10340,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10340=1,IF(F10340=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93990,"TC","See CPT",null,239.12699999999998,null,239.12699999999998,null,"000",0,0,0,1,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10342,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10342,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10342=1,IF(F10342=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},93998,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,0,0,0,1,1,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10369,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10369,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10369=1,IF(F10369=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},94375,"TC","See CPT",null,45.741,null,45.741,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10385,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10385,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10385=1,IF(F10385=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},94621,"TC","See CPT",null,165.59399999999999,null,165.59399999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10398,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10398,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10398=1,IF(F10398=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},94680,"TC","See CPT",null,76.427999999999997,null,76.427999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10422,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10422,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10422=1,IF(F10422=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},94772,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10445,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10445,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10445=1,IF(F10445=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95070,null,"See CPT",null,64.847999999999999,null,64.847999999999999,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10465,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10465,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10465=1,IF(F10465=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95180,null,"See CPT",null,243.18,null,178.911,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10488,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10488,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10488=1,IF(F10488=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95722,null,"See CPT",null,440.61900000000003,null,431.35500000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10495,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10495,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10495=1,IF(F10495=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95782,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10526,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10526,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10526=1,IF(F10526=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95812,null,"See CPT",null,643.84799999999996,null,643.84799999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10542,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10542,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10542=1,IF(F10542=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95824,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10550,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10550,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10550=1,IF(F10550=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95852,null,"See CPT",null,32.423999999999999,null,9.2639999999999993,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10567,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10567,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10567=1,IF(F10567=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95866,null,"See CPT",null,245.49600000000001,null,245.49600000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10593,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10593,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10593=1,IF(F10593=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95875,26,"See CPT",null,100.746,null,100.746,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10614,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10614,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10614=1,IF(F10614=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95909,"TC","See CPT",null,119.85299999999999,null,119.85299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10636,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10636,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10636=1,IF(F10636=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95924,null,"See CPT",null,270.97199999999998,null,270.97199999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10643,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10643,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10643=1,IF(F10643=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95926,"TC","See CPT",null,220.01999999999998,null,220.01999999999998,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10673,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10673,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10673=1,IF(F10673=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95943,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10690,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10690,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A10690=1,IF(F10690=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95962,26,"See CPT",null,297.60599999999999,null,297.60599999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10697,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10697,1)","v":1},{"$f":"IF(A10697=1,IF(F10697=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A10697=1,IF(F10697=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95966,26,"See CPT",null,366.50700000000001,null,366.50700000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10715,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10715,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10715=1,IF(F10715=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},95999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10740,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10740,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10740=1,IF(F10740=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},96139,null,"See CPT",null,67.163999999999987,null,67.163999999999987,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10758,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10758,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10758=1,IF(F10758=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},96368,null,"See CPT",null,38.792999999999999,null,38.792999999999999,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10769,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10769,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10769=1,IF(F10769=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},96401,null,"See CPT",null,152.27699999999999,null,152.27699999999999,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10801,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10801,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10801=1,IF(F10801=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},96913,null,"See CPT",null,276.18299999999999,null,276.18299999999999,null,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10812,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10812,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10812=1,IF(F10812=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},97010,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10825,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10825,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A10825=1,IF(F10825=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A10825=1,IF(F10825=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},97036,null,"See CPT",null,60.795000000000002,null,60.795000000000002,null,"000",0,0,0,9,9,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10841,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10841,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10841=1,IF(F10841=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},97155,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10862,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10862,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10862=1,IF(F10862=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},97545,null,"See CPT",null,157.70733263999998,null,157.70733263999998,null,"000",0,0,0,9,0,0,0,0,0,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10888,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10888,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10888=1,IF(F10888=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},98928,null,"See CPT",null,125.06400000000001,null,100.746,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10905,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10905,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10905=1,IF(F10905=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99002,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10917,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10917,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10917=1,IF(F10917=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99072,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10948,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10948,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10948=1,IF(F10948=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99203,null,"See CPT",null,194.54399999999998,null,141.85500000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10960,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10960,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10960=1,IF(F10960=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99221,null,"See CPT",null,169.64699999999999,null,169.64699999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10985,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10985,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10985=1,IF(F10985=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99282,null,"See CPT",null,71.795999999999992,null,71.795999999999992,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E10990,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F10990,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A10990=1,IF(F10990=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99291,null,"See CPT",null,483.46499999999997,null,370.56,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11014,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11014,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11014=1,IF(F11014=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99342,null,"See CPT",null,130.85399999999998,null,130.85399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11033,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11033,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11033=1,IF(F11033=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99375,null,"See CPT",null,177.17400000000001,null,148.22399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11057,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11057,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11057=1,IF(F11057=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99407,null,"See CPT",null,49.793999999999997,null,43.424999999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11076,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11076,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11076=1,IF(F11076=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99449,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11086,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11086,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11086=1,IF(F11086=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99460,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11113,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11113,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11113=1,IF(F11113=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99491,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11133,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11133,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11133=1,IF(F11133=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99512,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11137,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11137,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11137=1,IF(F11137=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},99605,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11162,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11162,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11162=1,IF(F11162=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0016M",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11180,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11180,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11180=1,IF(F11180=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0072T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11205,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11205,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11205=1,IF(F11205=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0098U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11212,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11212,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11212=1,IF(F11212=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0102U",null,"See CPT",null,1630.2294921600001,null,1630.2294921600001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11241,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11241,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11241=1,IF(F11241=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0127U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11255,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11255,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11255=1,IF(F11255=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0141U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11265,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11265,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11265=1,IF(F11265=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0151U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11284,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11284,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11284=1,IF(F11284=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0184T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11308,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11308,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11308=1,IF(F11308=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0213U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11331,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11331,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11331=1,IF(F11331=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0227U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11345,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11345,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11345=1,IF(F11345=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0237T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11360,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11360,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11360=1,IF(F11360=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0270T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11388,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11388,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11388=1,IF(F11388=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0345T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11407,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11407,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11407=1,IF(F11407=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0380R",null,"Job modification",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11431,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11431,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11431=1,IF(F11431=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0409A",null,"Claimant - dinner",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11432,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11432,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11432=1,IF(F11432=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0409T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11457,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11457,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11457=1,IF(F11457=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0427T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11473,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11473,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11473=1,IF(F11473=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0442T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11500,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11500,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11500=1,IF(F11500=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0474T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11516,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11516,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11516=1,IF(F11516=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0491T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11529,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11529,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A11529=1,IF(F11529=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A11529=1,IF(F11529=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0502F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11559,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11559,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11559=1,IF(F11559=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0523T",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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11576,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11576,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11576=1,IF(F11576=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0535T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11596,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11596,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11596=1,IF(F11596=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0551T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11605,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11605,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11605=1,IF(F11605=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0557T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11620,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11620,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11620=1,IF(F11620=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0570T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11652,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11652,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11652=1,IF(F11652=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0622T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11663,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11663,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11663=1,IF(F11663=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0633T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11677,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11677,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11677=1,IF(F11677=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"0811V",null,"Assessment services - intern",null,8.4330417600000001,null,8.4330417600000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11702,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11702,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11702=1,IF(F11702=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1002F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11724,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11724,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11724=1,IF(F11724=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1034F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11727,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11727,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11727=1,IF(F11727=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1038F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11748,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11748,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11748=1,IF(F11748=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1067M",null,"Assess impeds to rtrn to work, mentor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11774,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11774,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11774=1,IF(F11774=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1111F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11791,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11791,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11791=1,IF(F11791=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1126M",null,"Additional Complex IME Provider",null,768.92,null,768.92,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11803,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11803,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11803=1,IF(F11803=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1135M",null,"Ime, late cancellation fee, psychiatrist",null,371.28487968000002,null,371.28487968000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11828,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11828,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11828=1,IF(F11828=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1170F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11850,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11850,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11850=1,IF(F11850=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1225M",null,"Nurse case management travel expenses (parking, tolls, ferry, lodging, airfare)",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11871,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11871,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11871=1,IF(F11871=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1302W",null,"Stay at work tools & equipment",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11875,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11875,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11875=1,IF(F11875=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1306W",null,"Stay at work materials",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11895,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11895,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11895=1,IF(F11895=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"1726M",null,"PGAP Coordination 11-20 Minutes",null,52.3566,null,49.633199999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11922,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11922,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11922=1,IF(F11922=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"2029F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11947,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11947,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11947=1,IF(F11947=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3019F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11956,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11956,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11956=1,IF(F11956=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3037F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11972,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11972,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11972=1,IF(F11972=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3066F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E11999,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F11999,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A11999=1,IF(F11999=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3118F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12019,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12019,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12019=1,IF(F12019=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3250F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12023,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12023,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12023=1,IF(F12023=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3267F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12048,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12048,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12048=1,IF(F12048=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3318F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12060,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12060,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12060=1,IF(F12060=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3341F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12095,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12095,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12095=1,IF(F12095=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3493F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12103,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12103,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12103=1,IF(F12103=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3503F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12120,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12120,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12120=1,IF(F12120=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"3725F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12146,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12146,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12146=1,IF(F12146=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4013F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12167,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12167,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12167=1,IF(F12167=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4049F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12174,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12174,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12174=1,IF(F12174=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4056F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12188,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12188,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12188=1,IF(F12188=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4079F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12217,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12217,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12217=1,IF(F12217=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4159F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12231,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12231,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12231=1,IF(F12231=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4179F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12246,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12246,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12246=1,IF(F12246=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4196F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12268,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12268,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12268=1,IF(F12268=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4271F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12293,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12293,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12293=1,IF(F12293=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"4541F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12311,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12311,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12311=1,IF(F12311=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"5015F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12322,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12322,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12322=1,IF(F12322=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"5200F",null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12354,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12354,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12354=1,IF(F12354=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"8901H",null,"Attendant svcs by department approved sp",null,14.566163040000001,null,14.566163040000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12365,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12365,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12365=1,IF(F12365=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"8971H",null,"Home health aid svscs per 15 mins",null,7.9289496000000002,null,7.9289496000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12378,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12378,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12378=1,IF(F12378=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"9974M",null,"INTERPRETER SYSTEM PER MINUTE",null,1.0302,null,1.0302,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12394,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12394,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12394=1,IF(F12394=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A0140",null,"Nonemergency transport air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12419,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12419,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12419=1,IF(F12419=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A0431",null,"Rotary wing air transport",null,7495.3778874099853,null,7495.3778874099853,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12439,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12439,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12439=1,IF(F12439=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4218",null,"Sterile saline or water",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12462,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12462,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12462=1,IF(F12462=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4255",null,"Glucose monitor platforms",null,4.8857999999999997,null,4.8857999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12482,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12482,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12482=1,IF(F12482=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4285",null,"Replcmnt breast pump bottle",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12491,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12491,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12491=1,IF(F12491=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4312",null,"Cath w/o bag 2-way silicone",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12519,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12519,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12519=1,IF(F12519=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4355",null,"Bladder irrigation tubing",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12538,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12538,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12538=1,IF(F12538=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4378",null,"Drainable rubber pch w/o fp",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12543,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12543,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12543=1,IF(F12543=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4383",null,"Urinary rubber pouch w/o fp",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12567,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12567,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12567=1,IF(F12567=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4410",null,"Ost skn barr extnd >4 sq",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12586,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12586,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12586=1,IF(F12586=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4429",null,"Urine ost pouch w bltinconv",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12610,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12610,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12610=1,IF(F12610=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4510",null,"Full length surg stocking",null,124.13,null,124.13,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12629,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12629,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12629=1,IF(F12629=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4595",null,"Tens suppl 2 lead per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12639,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12639,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12639=1,IF(F12639=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4613",null,"Battery charger",null,191.75556912000002,null,191.75556912000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12664,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12664,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12664=1,IF(F12664=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12671,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12671,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12671=1,IF(F12671=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4657",null,"Syringe w/wo needle",null,0.82,null,0.82,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12689,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12689,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12689=1,IF(F12689=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4722",null,"Dialys sol fld vol > 1999cc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12714,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12714,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12714=1,IF(F12714=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A4913",null,"Misc dialysis supplies noc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12736,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12736,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12736=1,IF(F12736=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A5082",null,"Continent stoma catheter",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12751,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12751,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12751=1,IF(F12751=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A5501",null,"Diabetic custom molded shoe",null,226.4502,null,226.4502,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12765,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12765,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12765=1,IF(F12765=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6021",null,"Collagen dressing <=16 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12794,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12794,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12794=1,IF(F12794=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6222",null,"Gauze <=16 in no w/sal w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12812,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12812,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12812=1,IF(F12812=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6243",null,"Hydrogel drg >16<=48 w/o bdr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12818,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12818,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12818=1,IF(F12818=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6250",null,"Skin seal protect moisturizr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12837,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12837,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12837=1,IF(F12837=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6411",null,"Non-sterile eye pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12861,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12861,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12861=1,IF(F12861=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6503",null,"Compres burngarment facehood",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12884,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12884,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12884=1,IF(F12884=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A6544",null,"Gc stocking garter belt",null,107.25,null,107.25,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12905,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12905,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12905=1,IF(F12905=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A7018",null,"Water distilled w/nebulizer",null,0.40800000000000003,null,0.40800000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12922,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12922,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12922=1,IF(F12922=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A7040",null,"One way chest drain valve",null,46.869000000000007,null,46.869000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12934,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12934,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12934=1,IF(F12934=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A7506",null,"Hmes/trachvalve adhesivedisk",null,0.3876,null,0.3876,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12946,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12946,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12946=1,IF(F12946=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A8000",null,"Soft protect helmet prefab",null,281.99348400000002,null,281.99348400000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12981,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12981,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12981=1,IF(F12981=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A9509",null,"Iodine i-123 sod iodide mil",null,1027.05,null,1027.05,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E12983,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F12983,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A12983=1,IF(F12983=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A9512",null,"Tc99m pertechnetate",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13010,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13010,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13010=1,IF(F13010=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A9551",null,"Tc99m succimer",null,683.34,null,683.34,null,"000",0,0,0,0,0,0,0,0,0,null,"D",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13026,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13026,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13026=1,IF(F13026=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A9568",null,"Technetium tc99m arcitumomab",null,1235,null,1235,null,"000",0,0,0,0,0,0,0,0,0,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13039,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13039,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13039=1,IF(F13039=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"A9583",null,"Gadofosveset trisodium inj",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13069,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13069,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13069=1,IF(F13069=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"B4087",null,"Gastro/jejuno tube, std",null,34.884,null,34.884,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13082,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13082,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13082=1,IF(F13082=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"B4157",null,"Ef special metabolic inherit",null,6.71,null,6.71,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13093,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13093,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13093=1,IF(F13093=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"B4180",null,"Parenteral sol carb > 50%",null,30.079799999999999,null,30.079799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13129,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13129,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A13129=1,IF(F13129=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A13129=1,IF(F13129=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C1728",null,"Cath, brachytx seed adm",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13132,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13132,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13132=1,IF(F13132=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C1731",null,"Cath, ep, 20 or more elec",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13154,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13154,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13154=1,IF(F13154=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C1766",null,"Intro/sheath,strble,non-peel",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13179,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13179,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13179=1,IF(F13179=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C1816",null,"Receiver/transmitter, neuro",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13197,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13197,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13197=1,IF(F13197=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C1877",null,"Stent, non-coat/cov w/o del",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13208,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13208,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13208=1,IF(F13208=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C1889",null,"Implant/insert device, noc",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13234,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13234,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13234=1,IF(F13234=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C2626",null,"Infusion pump, non-prog,temp",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13255,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13255,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13255=1,IF(F13255=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13277,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13277,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13277=1,IF(F13277=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C8920",null,"Mra w/o fol w/cont, pelvis",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13284,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13284,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13284=1,IF(F13284=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C8927",null,"Tee w or w/o fol w/cont, mon",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13301,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13301,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13301=1,IF(F13301=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C9054",null,"Injection, lefamulin",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13327,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13327,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13327=1,IF(F13327=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C9353",null,"Neurawrap nerve protector,cm",null,"Facility Only",null,"Facility Only",null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13344,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13344,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13344=1,IF(F13344=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C9484",null,"Injection, eteplirsen",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13356,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13356,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13356=1,IF(F13356=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C9607",null,"Perc d-e cor revasc chro sin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13381,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13381,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13381=1,IF(F13381=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"C9765",null,"Revasc intra lithotrip-stent",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13403,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13403,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13403=1,IF(F13403=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D0171",null,"Re-eval post-op visit",null,66.004567200000011,null,66.004567200000011,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13424,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13424,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13424=1,IF(F13424=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D0350",null,"Oral/facial photo images",null,74.028034079999998,null,74.028034079999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13429,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13429,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13429=1,IF(F13429=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D0367",null,"Cone beam ct interp both jaw",null,377.29197792000002,null,377.29197792000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13453,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13453,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13453=1,IF(F13453=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D0422",null,"Collect & prep genetic samp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13466,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13466,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13466=1,IF(F13466=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D0479",null,"Tissue in-situ hybridization",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13482,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13482,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13482=1,IF(F13482=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D0702",null,"2d cephal radio image",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13509,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13509,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13509=1,IF(F13509=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D1527",null,"Remove bilat space main, man",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13525,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13525,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13525=1,IF(F13525=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D2335",null,"Resin 4/> surf or w incis an",null,326.45218320000004,null,326.45218320000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13552,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13552,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13552=1,IF(F13552=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D2710",null,"Crown resin-based indirect",null,1001.6416238400001,null,1001.6416238400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13572,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13572,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13572=1,IF(F13572=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D2915",null,"Recement cast or prefab post",null,123.08250240000001,null,123.08250240000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13576,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13576,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13576=1,IF(F13576=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D2929",null,"Prefab porc/ceram crown pri",null,373.72132512000002,null,373.72132512000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13601,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13601,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13601=1,IF(F13601=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D2990",null,"Resin infiltration of lesion",null,188.19440640000002,null,188.19440640000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13613,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13613,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13613=1,IF(F13613=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D3331",null,"Non-surg tx root canal obs",null,669.84396336000009,null,669.84396336000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13630,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13630,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13630=1,IF(F13630=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D3429",null,"Bone graft peri each addl",null,569.94970032000003,null,569.94970032000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13651,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13651,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13651=1,IF(F13651=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D4231",null,"Ana crown exp 1-3 per quad",null,618.11150544000009,null,618.11150544000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13680,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13680,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13680=1,IF(F13680=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D4910",null,"Periodontal maint procedures",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13698,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13698,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13698=1,IF(F13698=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D5282",null,"Remove unil part denture,max",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13717,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13717,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13717=1,IF(F13717=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D5670",null,"Replc tth&acrlc on mtl frmwk",null,773.30887920000009,null,773.30887920000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13727,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13727,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13727=1,IF(F13727=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D5750",null,"Denture reln cmplt max lab",null,482.54222016000006,null,482.54222016000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13741,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13741,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13741=1,IF(F13741=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D5866",null,"Overdenture partial mandib",null,2317.2486480000002,null,2317.2486480000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13770,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13770,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13770=1,IF(F13770=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D5953",null,"Adult speech aid",null,2269.6644484800004,null,2269.6644484800004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13784,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13784,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13784=1,IF(F13784=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D5992",null,"Adjust max prost appliance",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13799,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13799,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13799=1,IF(F13799=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6058",null,"Abutment supported crown",null,1446.72349536,null,1446.72349536,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13827,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13827,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13827=1,IF(F13827=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6090",null,"Repair implant",null,763.50008592000006,null,763.50008592000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13846,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13846,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13846=1,IF(F13846=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6114",null,"Implnt/abut fixed dent max",null,8766.8347852800016,null,8766.8347852800016,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13864,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13864,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13864=1,IF(F13864=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6211",null,"Bridge base metal cast",null,1096.1904096000001,null,1096.1904096000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13875,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13875,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13875=1,IF(F13875=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6253",null,"Provisional pontic",null,791.15164128000015,null,791.15164128000015,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13896,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13896,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13896=1,IF(F13896=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6634",null,"Onlay titanium",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13906,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13906,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13906=1,IF(F13906=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D6780",null,"Crown 3/4 high noble metal",null,1134.54342144,null,1134.54342144,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13925,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13925,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13925=1,IF(F13925=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7210",null,"Rem imp tooth w mucoper flp",null,291.65932224000005,null,291.65932224000005,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13949,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13949,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13949=1,IF(F13949=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7296",null,"Corticotomy, 1-3 teeth",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13972,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13972,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13972=1,IF(F13972=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7473",null,"Remove torus mandibularis",null,852.69289248000018,null,852.69289248000018,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E13992,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F13992,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A13992=1,IF(F13992=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7710",null,"Maxilla open reduct compound",null,4546.1971526400002,null,4546.1971526400002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14015,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14015,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14015=1,IF(F14015=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7873",null,"Tmj arthroscopy lysis adhesn",null,2156.2017048000002,null,2156.2017048000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14016,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14016,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14016=1,IF(F14016=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7874",null,"Tmj arthroscopy disc reposit",null,2723.5994385600002,null,2723.5994385600002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14044,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14044,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14044=1,IF(F14044=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7962",null,"Lingual frenectomy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14059,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14059,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14059=1,IF(F14059=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D7996",null,"Implant mandible for augment",null,4523.3554766400002,null,4523.3554766400002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14073,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14073,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14073=1,IF(F14073=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D8220",null,"Fixed appliance therapy habt",null,1029.2931792000002,null,1029.2931792000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14096,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14096,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14096=1,IF(F14096=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D9219",null,"Eval mod/deep sed/gen anest",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14120,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14120,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14120=1,IF(F14120=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D9934",null,"Clean rem part denture max",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14141,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14141,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14141=1,IF(F14141=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"D9990",null,"Trans or sign language svcs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14157,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14157,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14157=1,IF(F14157=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0116","NU","Crutch underarm each no wood",null,28.2744,null,28.2744,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14170,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14170,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14170=1,IF(F14170=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0144","NU","Enclosed walker w rear seat",null,1070.7969999999998,null,1070.7969999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14200,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14200,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14200=1,IF(F14200=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0171","NU","Commode chair non-electric",null,301.02703488000003,null,301.02703488000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14217,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14217,1)","v":1},{"$f":"IF(A14217=1,IF(F14217=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A14217=1,IF(F14217=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0189","NU","Lambswool sheepskin pad",null,52.448399999999999,null,52.448399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14224,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14224,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14224=1,IF(F14224=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0197","NU","Air pressure pad for mattres",null,411.84499999999997,null,411.84499999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14242,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14242,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14242=1,IF(F14242=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14267,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14267,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14267=1,IF(F14267=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0261","RR","Hosp bed semi-electr w/o mat",null,176.505,null,176.505,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14289,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14289,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14289=1,IF(F14289=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0292","RR","Hosp bed var ht no sr w/matt",null,91.782599999999988,null,91.782599999999988,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14310,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14310,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14310=1,IF(F14310=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0305","RR","Rails bed side half length",null,25.887399999999996,null,25.887399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14318,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14318,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14318=1,IF(F14318=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0326","NU","Urinal female jug-type",null,11.6586,null,11.6586,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14347,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14347,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14347=1,IF(F14347=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0447",null,"Port o2 cont, liq over 4 lpm",null,100.3884,null,100.3884,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14365,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14365,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14365=1,IF(F14365=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0472","RR","Rad w backup invasive intrfc",null,823.68999999999994,null,823.68999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14368,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14368,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14368=1,IF(F14368=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0481","NU","Intrpulmnry percuss vent sys",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14389,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14389,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14389=1,IF(F14389=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0572","RR","Aerosol compressor adjust pr",null,43.067220000000006,null,43.067220000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14415,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14415,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14415=1,IF(F14415=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0619",null,"Apnea monitor w recorder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14432,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14432,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14432=1,IF(F14432=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0637","NU","Combination sit to stand sys",null,4892.7185999999992,null,4892.7185999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14444,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14444,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14444=1,IF(F14444=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0650","RR","Pneuma compresor non-segment",null,85.512720000000002,null,85.512720000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14475,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14475,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14475=1,IF(F14475=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0675","NU","Pneumatic compression device",null,4361.7357999999995,null,4361.7357999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14487,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14487=1,IF(F14487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0730",null,"Tens four lead",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14499,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14499,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14499=1,IF(F14499=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14516,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14516,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14516=1,IF(F14516=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0780","NU","Mech amb infusion pump <8hrs",null,12.311400000000001,null,12.311400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14536,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14536,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14536=1,IF(F14536=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0850","NU","Traction stand free standing",null,124.7256,null,124.7256,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14563,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14563,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14563=1,IF(F14563=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0940","NU","Trapeze bar free standing",null,441.26659999999998,null,441.26659999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14579,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14579,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14579=1,IF(F14579=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0954","RR","Foot box, any type each foot",null,5.94,null,5.94,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14592,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14592,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14592=1,IF(F14592=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0961","NU","Wheelchair brake extension",null,26.2242,null,26.2242,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14613,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14613,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14613=1,IF(F14613=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E0980","RR","Wheelchair safety vest",null,3.92496,null,3.92496,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14640,1)","v":2},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14640,1)","v":1},false,{"$f":"IF(A14640=1,IF(F14640=Lookup!$A$13,2))","v":false},"E1004","RR","Pwr seat recline mech",null,611.8839999999999,null,611.8839999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14660,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14660,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14660=1,IF(F14660=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1020","NU","Residual limb support system",null,347.13059999999996,null,347.13059999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14664,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14664,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14664=1,IF(F14664=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1029","NU","W/c vent tray fixed",null,590.70339999999999,null,590.70339999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14689,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14689,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14689=1,IF(F14689=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1086","NU","Hemi-wheelchair detachable a",null,2288.6855999999998,null,2288.6855999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14707,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14707,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14707=1,IF(F14707=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1130","NU","Whlchr stand fxd arm ft rest",null,823.68999999999994,null,823.68999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14732,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14732,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14732=1,IF(F14732=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1221","NU","Wheelchair spec size w foot",null,588.34999999999991,null,588.34999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14750,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14750,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A14750=1,IF(F14750=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1231",null,"Rigid ped w/c tilt-in-space",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14761,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14761,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14761=1,IF(F14761=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1250","NU","Wheelchair lightwt fixed arm",null,1090.8049999999998,null,1090.8049999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14787,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14787,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14787=1,IF(F14787=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1356","RR","Batt pack/cart, port conc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14808,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14808,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14808=1,IF(F14808=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1580","RR","Unipuncture control system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14811,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14811,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14811=1,IF(F14811=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1594","RR","Cycler dialysis machine",null,933.49620000000004,null,933.49620000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14837,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14837,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14837=1,IF(F14837=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E1815","RR","Adjust ankle ext/flex device",null,150.02160000000001,null,150.02160000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14858,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14858,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14858=1,IF(F14858=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2204","NU","Frame depth 22 to 25 in",null,882.91200000000003,null,882.91200000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14872,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14872,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14872=1,IF(F14872=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2212","NU","Pneumatic prop tire tube",null,6.8748000000000005,null,6.8748000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14887,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14887,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14887=1,IF(F14887=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2227","RR","Gear reduction drive wheel",null,388.31099999999998,null,388.31099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14915,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14915,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14915=1,IF(F14915=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2323","NU","Special joystick handle",null,69.961800000000011,null,69.961800000000011,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14934,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14934,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14934=1,IF(F14934=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2340","RR","W/c wdth 20-23 in seat frame",null,42.549300000000002,null,42.549300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14939,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14939,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14939=1,IF(F14939=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2343","NU","W/c dpth 22-25 in seat frame",null,851.08799999999997,null,851.08799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14959,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14959,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14959=1,IF(F14959=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2367","NU","Battery charger, dual mode",null,419.60759999999999,null,419.60759999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E14982,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F14982,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A14982=1,IF(F14982=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2382","NU","Tube, pneum wheel drive tire",null,19.900200000000002,null,19.900200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15006,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15006,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A15006=1,IF(F15006=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2395","NU","Caster wheel excludes tire",null,51.652799999999999,null,51.652799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15019,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15019,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A15019=1,IF(F15019=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2504","NU","Sgd prerec msg>20min <=40min",null,1872.9444000000001,null,1872.9444000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15035,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15035,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A15035=1,IF(F15035=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2603","NU","Skin protect wc cus wd <22in",null,133.6506,null,133.6506,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15062,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15062,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A15062=1,IF(F15062=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"E2631","NU","Elevat proximal arm support",null,287.91539999999998,null,287.91539999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15082,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15082,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15082=1,IF(F15082=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0082",null,"Care man h v ext pt 30 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15103,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15103,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15103=1,IF(F15103=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0118",null,"Glaucoma scrn hgh risk direc",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,0,0,0,0,0,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15123,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15123,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15123=1,IF(F15123=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0145",null,"Scr c/v cyto,thinlayer,rescr",null,37.615799999999993,null,37.615799999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15132,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15132,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15132=1,IF(F15132=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0159",null,"Hhc pt maint ea 15 min",null,44.129067840000012,null,44.129067840000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15147,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15147,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A15147=1,IF(F15147=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0202",26,"Scr mammo bi incl cad",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15175,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15175,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A15175=1,IF(F15175=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0255","TC","Current percep threshold tst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15190,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15190,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15190=1,IF(F15190=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0282",null,"Elect stim wound care not pd",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15204,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15204,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15204=1,IF(F15204=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0307",null,"Cbc without platelet",null,9.1873999999999985,null,9.1873999999999985,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15233,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15233,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15233=1,IF(F15233=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0405",null,"Ekg interpret & report preve",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,2,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15251,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15251,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15251=1,IF(F15251=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0424",null,"Pulmonary rehab w exer",null,53.268000000000001,null,23.16,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15270,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15270,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15270=1,IF(F15270=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0448",null,"Place perm pacing cardiovert",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15280,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15280,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15280=1,IF(F15280=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0464",null,"Colorec ca scr, sto bas dna",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15294,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15294,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15294=1,IF(F15294=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0483",null,"Drug test def 22+ classes",null,350.62639999999999,null,350.62639999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15309,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15309,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15309=1,IF(F15309=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G0508",null,"Crit care telehea consult 60",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,9,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15330,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15330,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15330=1,IF(F15330=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G1009",null,"Cdsm sage health",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15355,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15355,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15355=1,IF(F15355=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2011",null,"Alcohol/sub abuse assess",null,29.529,null,29.529,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15377,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15377,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15377=1,IF(F15377=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2076",null,"Intake act w/med exam",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15398,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15398,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15398=1,IF(F15398=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2100",null,"Pt 66+ frailty and med dem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15402,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15402,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15402=1,IF(F15402=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2107",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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15422,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15422,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15422=1,IF(F15422=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2140",null,"Leg pain vas 6-20wk = 3",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15449,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15449,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15449=1,IF(F15449=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2181",null,"Bmi not doc medrsn ptref",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15465,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15465,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15465=1,IF(F15465=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2197",null,"Screen hlthy etoh use",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15478,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15478,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15478=1,IF(F15478=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G2210",null,"No neck fs prom no rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15502,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15502,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15502=1,IF(F15502=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G6011",null,"Radiation treatment delivery",null,478.83299999999997,null,478.83299999999997,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15525,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15525,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15525=1,IF(F15525=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8421",null,"Bmi not calculated",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15545,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15545,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15545=1,IF(F15545=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8484",null,"Flu immunize no admin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15550,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15550,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15550=1,IF(F15550=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8536",null,"No doc elder mal scrn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15575,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15575,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15575=1,IF(F15575=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8601",null,"No elig tpa init w/in 3 hrs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15587,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15587,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15587=1,IF(F15587=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8658",null,"Rafscrs llfai no scor + surv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15604,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15604,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15604=1,IF(F15604=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8711",null,"Pres antibiotic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15630,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15630,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15630=1,IF(F15630=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8825",null,"Pt not disch to home day#7",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15647,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15647,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15647=1,IF(F15647=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8854",null,"Reas no adhere pos air pres",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15673,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15673,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15673=1,IF(F15673=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8912",null,"Pt doc with wrong event",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15694,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15694,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15694=1,IF(F15694=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8952",null,"Pre-htn/htn, no f/u, not gvn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15697,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15697,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15697=1,IF(F15697=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G8958",null,"Assess vol mgmt not doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15723,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15723,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15723=1,IF(F15723=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9050",null,"Oncology work-up evaluation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15734,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15734,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15734=1,IF(F15734=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9061",null,"Onc prac cond noadd by guide",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15752,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15752,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15752=1,IF(F15752=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9080",null,"Onc dx prostate w/rise psa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15777,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15777,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15777=1,IF(F15777=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9107",null,"Onc dx pancreatic unresectab",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15795,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15795,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15795=1,IF(F15795=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9131",null,"Onc dx brst unknown nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15820,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15820,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15820=1,IF(F15820=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9223",null,"Pjp proph ordered cd4 low",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15838,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15838,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15838=1,IF(F15838=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9269",null,"Doc no comp or mort w in 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15849,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15849,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15849=1,IF(F15849=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9282",null,"Doc medrsn no histo type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15862,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15862,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15862=1,IF(F15862=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9295",null,"Non cutaneous loc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15892,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15892,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15892=1,IF(F15892=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9351",null,"Doc >1 sinus ct w 90d dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15905,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15905,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15905=1,IF(F15905=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9368",null,">= 2 same hi-rsk med not ord",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15921,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15921,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15921=1,IF(F15921=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15948,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15948,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15948=1,IF(F15948=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9431",null,"Patho rpt no pt ctg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15968,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15968,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15968=1,IF(F15968=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9474",null,"Diet counsel at hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15985,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15985,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15985=1,IF(F15985=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E15997,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F15997,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A15997=1,IF(F15997=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9521",null,"Er and ip hosp <2 in 12 mos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16028,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16028,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16028=1,IF(F16028=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9582",null,"Door to punc time >2hr, nrg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16040,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16040,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16040=1,IF(F16040=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9604",null,"Pt surv results not avail",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16047,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16047,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16047=1,IF(F16047=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9611",null,"No doc order anti-plat rng",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16070,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16070,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16070=1,IF(F16070=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9638",null,"No doc >1 dose reduc tech",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16094,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16094,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16094=1,IF(F16094=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9666",null,"Fas/dir ldl 70-189mg/dl mst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16113,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16113,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16113=1,IF(F16113=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9702",null,"Pt use hosp during msmt per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16137,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16137,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A16137=1,IF(F16137=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A16137=1,IF(F16137=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9726",null,"Refused to participate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16156,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16156,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16156=1,IF(F16156=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9753",null,"Doc no dicom, ct other fac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16166,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16166,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16166=1,IF(F16166=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9764",null,"Pt treatd w/oral syst or bio",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16193,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16193,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16193=1,IF(F16193=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9791",null,"Most rct tob stat free",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16195,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16195,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16195=1,IF(F16195=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9793",null,"Pt on daily asa/antiplat",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16217,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16217,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16217=1,IF(F16217=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9831",null,"Ajcc stg brt ca dx ii or iii",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16242,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16242,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16242=1,IF(F16242=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9878",null,"2 em core ms mo 7-9 wl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16260,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16260,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16260=1,IF(F16260=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9901",null,"Pt 66+ snp or ltc pos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16285,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16285,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16285=1,IF(F16285=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9927",null,"Doc no warf /fda  pt trial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16292,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16292,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16292=1,IF(F16292=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"G9939",null,"Same path/derm perf biopsy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16321,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16321,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16321=1,IF(F16321=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"H0002",null,"Alcohol and/or drug screenin",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16339,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16339,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16339=1,IF(F16339=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"H0020",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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16345,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16345,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16345=1,IF(F16345=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"H0026",null,"Alcohol and/or drug preventi",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16364,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16364,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16364=1,IF(F16364=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"H0045",null,"Respite not-in-home per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16388,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16388,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16388=1,IF(F16388=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"H2018",null,"Psysoc rehab svc, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16411,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16411,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16411=1,IF(F16411=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0129",null,"Abatacept injection",null,57.831000000000003,null,57.831000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16425,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16425,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16425=1,IF(F16425=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0202",null,"Injection, alemtuzumab",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16440,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16440,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16440=1,IF(F16440=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0280",null,"Aminophyllin 250 mg inj",null,9.5009999999999994,null,9.5009999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16468,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16468,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16468=1,IF(F16468=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0490",null,"Belimumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16487,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16487=1,IF(F16487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0587",null,"Inj, rimabotulinumtoxinb",null,11.971,null,11.971,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16492,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16492,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16492=1,IF(F16492=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0594",null,"Busulfan injection",null,2.1970000000000001,null,2.1970000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16512,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16512,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16512=1,IF(F16512=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0691",null,"Inj lefamulin 1 mg",null,0.72399999999999998,null,0.72399999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16535,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16535,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16535=1,IF(F16535=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0744",null,"Ciprofloxacin iv",null,0.98899999999999999,null,0.98899999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16559,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16559,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16559=1,IF(F16559=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J0896",null,"Inj luspatercept-aamt 0.25mg",null,36.292999999999999,null,36.292999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16580,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16580,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16580=1,IF(F16580=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1190",null,"Dexrazoxane hcl injection",null,207.49199999999999,null,207.49199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16596,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16596,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16596=1,IF(F16596=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1303",null,"Inj., ravulizumab-cwvz 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16609,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16609,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16609=1,IF(F16609=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16620,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16620,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16620=1,IF(F16620=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1450",null,"Fluconazole",null,3.1669999999999998,null,3.1669999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16638,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16638,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16638=1,IF(F16638=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1562",null,"Vivaglobin, inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16657,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16657,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16657=1,IF(F16657=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1630",null,"Haloperidol injection",null,1.4319999999999999,null,1.4319999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16685,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16685,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16685=1,IF(F16685=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1786",null,"Imuglucerase injection",null,43.435000000000002,null,43.435000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16700,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16700,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16700=1,IF(F16700=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J1930",null,"Lanreotide injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16714,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16714,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16714=1,IF(F16714=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J2001",null,"Lidocaine injection",null,2.5999999999999999E-2,null,2.5999999999999999E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16743,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16743,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16743=1,IF(F16743=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J2353",null,"Octreotide injection, depot",null,205.04300000000001,null,205.04300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16757,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16757,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16757=1,IF(F16757=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J2440",null,"Papaverin hcl injection",null,10.49,null,10.49,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16767,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16767,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16767=1,IF(F16767=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J2513",null,"Pentastarch 10% solution",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16786,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16786,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16786=1,IF(F16786=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J2720",null,"Inj protamine sulfate/10 mg",null,1.2030000000000001,null,1.2030000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16807,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16807,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16807=1,IF(F16807=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16828,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16828,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16828=1,IF(F16828=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J3031",null,"Inj., fremanezumab-vfrm 1 mg",null,1.35,null,1.35,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16854,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16854,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16854=1,IF(F16854=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J3302",null,"Triamcinolone diacetate inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16871,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16871,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16871=1,IF(F16871=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J3385",null,"Velaglucerase alfa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16883,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16883,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16883=1,IF(F16883=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J3470",null,"Hyaluronidase injection",null,60.26,null,60.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16908,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16908,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16908=1,IF(F16908=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7121",null,"5% dextrose in lac ringers",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16930,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16930,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16930=1,IF(F16930=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7194",null,"Factor ix complex",null,1.4850000000000001,null,1.4850000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16951,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16951,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16951=1,IF(F16951=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7300",null,"Intraut copper contraceptive",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16959,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16959,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16959=1,IF(F16959=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E16975,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F16975,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A16975=1,IF(F16975=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7328",null,"Gelsyn-3 injection 0.1 mg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17002,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17002,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17002=1,IF(F17002=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7517",null,"Mycophenolate mofetil oral",null,0.374,null,0.374,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17018,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17018,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17018=1,IF(F17018=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7614",null,"Levalbuterol non-comp unit",null,5.8999999999999997E-2,null,5.8999999999999997E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17031,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17031,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17031=1,IF(F17031=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J7635",null,"Atropine comp con",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17052,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17052,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17052=1,IF(F17052=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17079,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17079,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17079=1,IF(F17079=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J8565",null,"Gefitinib oral",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17081,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17081,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17081=1,IF(F17081=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J8600",null,"Melphalan oral 2 mg",null,0.12,null,0.12,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17103,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17103,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17103=1,IF(F17103=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9037",null,"Inj belantamab mafodont blmf",null,42.973999999999997,null,42.973999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17128,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17128,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17128=1,IF(F17128=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9153",null,"Inj daunorubicin, cytarabine",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17140,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17140,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17140=1,IF(F17140=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9185",null,"Fludarabine phosphate inj",null,75.176000000000002,null,75.176000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17157,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17157,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17157=1,IF(F17157=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9213",null,"Interferon alfa-2a inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17183,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17183,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17183=1,IF(F17183=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9270",null,"Plicamycin (mithramycin) inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17200,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17200,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17200=1,IF(F17200=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9311",null,"Inj rituximab, hyaluronidase",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17226,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17226,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17226=1,IF(F17226=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"J9400",null,"Inj, ziv-aflibercept, 1mg",null,7.5229999999999997,null,7.5229999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17229,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17229,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17229=1,IF(F17229=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0001","NU","Standard wheelchair",null,655.42599999999993,null,655.42599999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17250,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17250,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17250=1,IF(F17250=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0011","NU","Stnd wt pwr whlchr w control",null,7218.0909999999985,null,7218.0909999999985,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17276,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17276,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17276=1,IF(F17276=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0040","RR","Adjustable angle footplate",null,6.6830400000000001,null,6.6830400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17297,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17297,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17297=1,IF(F17297=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0053","NU","Elevate footrest articulate",null,98.328000000000003,null,98.328000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17311,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17311,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17311=1,IF(F17311=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0108","NU","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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17326,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17326,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A17326=1,IF(F17326=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0606",null,"Aed garment w elec analysis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17354,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17354,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17354=1,IF(F17354=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0815","RR","Pwc gp 1 std seat/back",null,359.14466016,null,359.14466016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17373,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17373,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17373=1,IF(F17373=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0828","NU","Pwc gp 2 xtra hd seat/back",null,9405.2044944000008,null,9405.2044944000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17391,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17391,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17391=1,IF(F17391=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0840","NU","Pwc gp2 xhd sing pow opt s/b",null,11090.762654400001,null,11090.762654400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17402,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17402,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17402=1,IF(F17402=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0849","RR","Pwc gp 3 std cap chair",null,801.39101327999992,null,801.39101327999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E17415,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F17415,1)","v":1},{"$error":"#VALUE!"},{"$f":"IF(A17415=1,IF(F17415=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"K0856","NU","Pwc gp3 std sing pow opt s/b",null,8947.0057247999994,null,8947.0057247999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18173,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18173,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18173=1,IF(F18173=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L6637",null,"Nudge control elbow lock",null,551.80230000000006,null,551.80230000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18191,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18191,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18191=1,IF(F18191=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L6680",null,"Test sock wrist disart/bel e",null,302.10759999999999,null,302.10759999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18210,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18210,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18210=1,IF(F18210=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L6707",null,"Term dev mech hook vol close",null,1785.9756,null,1785.9756,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18238,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18238,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18238=1,IF(F18238=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L6940",null,"Elbow disarticulation switch",null,12837.198100000001,null,12837.198100000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18259,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18259,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18259=1,IF(F18259=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L7360",null,"Six volt bat otto bock/eq ea",null,337.0453,null,337.0453,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18277,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18277,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18277=1,IF(F18277=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L7902",null,"Tension ring, vac erect dev",null,25.204608,null,25.204608,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18288,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18288,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18288=1,IF(F18288=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L8035",null,"Custom breast prosthesis",null,4567.5677000000005,null,4567.5677000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18314,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18314,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18314=1,IF(F18314=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L8470",null,"Pros sock single ply bk",null,8.4709000000000003,null,8.4709000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18335,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18335,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18335=1,IF(F18335=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L8608",null,"Arg ii ext com/sup/acc misc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18338,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18338,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18338=1,IF(F18338=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L8612",null,"Aqueous shunt prosthesis",null,919.77210000000002,null,919.77210000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18364,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18364,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18364=1,IF(F18364=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L8682",null,"Implt neurostim radiofq rec",null,6796.2906999999996,null,6796.2906999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18381,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18381,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18381=1,IF(F18381=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"L8701",null,"Pow ue rom dev ewh uprt cust",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18407,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18407,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18407=1,IF(F18407=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"M1018",null,"Pt dx hst cr pt sk lg cr scr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18424,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18424,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18424=1,IF(F18424=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"M1039",null,"Pt dx lum sp reg inf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18436,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18436,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18436=1,IF(F18436=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"M1057",null,"Aspirin not used, no rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18461,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18461,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18461=1,IF(F18461=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"M1122",null,"Docu dx degen neuro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18483,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18483,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18483=1,IF(F18483=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"P2028",null,"Cephalin floculation test",null,7.0289999999999999,null,7.0289999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18486,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18486,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18486=1,IF(F18486=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"P2033",null,"Blood thymol turbidity",null,7.0289999999999999,null,7.0289999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18509,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18509,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18509=1,IF(F18509=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"P9039",null,"Rbc deglycerolized",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18533,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18533,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18533=1,IF(F18533=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"P9100",null,"Pathogen test for platelets",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18546,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18546,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18546=1,IF(F18546=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q0092",null,"Set up port xray equipment",null,41.687999999999995,null,41.687999999999995,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18562,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18562,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18562=1,IF(F18562=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q0173",null,"Trimethobenzamide hcl 250mg",null,2.4500000000000002,null,2.4500000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18589,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18589,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18589=1,IF(F18589=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q0496",null,"Battery elec/combo vad, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18609,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18609,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18609=1,IF(F18609=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q1005",null,"Ntiol category 5",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18613,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18613,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18613=1,IF(F18613=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q2028",null,"Inj, sculptra, 0.5mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18634,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18634,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18634=1,IF(F18634=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4004",null,"Cast sup shoulder cast fbrgl",null,129.85624080000002,null,129.85624080000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18656,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18656,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18656=1,IF(F18656=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4026",null,"Cast sup hip spica fiberglas",null,125.91802080000001,null,125.91802080000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18681,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18681,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18681=1,IF(F18681=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4051",null,"Splint supplies misc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18693,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18693,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18693=1,IF(F18693=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4108",null,"Integra matrix",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18710,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18710,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18710=1,IF(F18710=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4128",null,"Flexhd/allopatchhd/matrixhd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18731,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18731,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18731=1,IF(F18731=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4152",null,"Dermapure 1 square cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18760,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18760,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18760=1,IF(F18760=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4182",null,"Transcyte, per sq centimeter",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18778,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18778,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18778=1,IF(F18778=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4221",null,"Amniowrap2 per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18797,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18797,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18797=1,IF(F18797=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q4244",null,"Procenta, per 200 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18807,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18807,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18807=1,IF(F18807=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q5002",null,"Hospice/home hlth in asst lv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18821,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18821,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18821=1,IF(F18821=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q5113",null,"Inj herzuma 10 mg",null,81.994,null,81.994,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18850,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18850,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18850=1,IF(F18850=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"Q9966",null,"Locm 200-299mg/ml iodine,1ml",null,0.318,null,0.318,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18864,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18864,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18864=1,IF(F18864=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"R0310",null,"Retraining tuition fees",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18879,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18879,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18879=1,IF(F18879=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0017",null,"Injection, aminocaproic acid",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18907,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18907,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18907=1,IF(F18907=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0126",null,"Inj follitropin alfa 75 iu",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18926,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18926,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18926=1,IF(F18926=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0171",null,"Bumetanide 0.5 mg",null,0.03,null,0.03,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18944,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18944,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18944=1,IF(F18944=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0207",null,"Paramedicintercep nonhospals",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18955,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18955,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18955=1,IF(F18955=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0270",null,"Home std case rate 30 days",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18976,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18976,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18976=1,IF(F18976=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0500",null,"Dispos cont lens",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E18992,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F18992,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A18992=1,IF(F18992=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S0601",null,"Screening proctoscopy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19005,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19005,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19005=1,IF(F19005=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S1002",null,"Custom item",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19029,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19029,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19029=1,IF(F19029=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S2095",null,"Transcath emboliz microspher",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19052,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19052,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19052=1,IF(F19052=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S2265",null,"Induced abortion 25-28 wks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19072,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19072,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19072=1,IF(F19072=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S3000",null,"Bilat dil retinal exam",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19077,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19077,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19077=1,IF(F19077=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S3630",null,"Eosinophil blood count",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19096,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19096,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19096=1,IF(F19096=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S3865",null,"Comp genet test hyp cardiomy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19124,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19124,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19124=1,IF(F19124=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S4981",null,"Insert levonorgestrel ius",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19139,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19139,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19139=1,IF(F19139=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S5101",null,"Adult day care per half day",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19153,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19153,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19153=1,IF(F19153=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S5131",null,"Homemaker service nos /diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19176,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19176,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19176=1,IF(F19176=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S5502",null,"Hit interim cath care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19200,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19200,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19200=1,IF(F19200=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S8080",null,"Scintimammography",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19221,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19221,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19221=1,IF(F19221=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19224,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19224,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19224=1,IF(F19224=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S8424",null,"Ready gradient sleeve",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19250,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19250,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19250=1,IF(F19250=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19261,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19261,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19261=1,IF(F19261=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19279,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19279,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19279=1,IF(F19279=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19304,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19304,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19304=1,IF(F19304=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19322,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19322,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19322=1,IF(F19322=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19347,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19347,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19347=1,IF(F19347=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S9475",null,"Ambulatory setting substance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19369,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19369,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19369=1,IF(F19369=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"S9590",null,"Ht irrigation diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19371,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19371,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19371=1,IF(F19371=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19398,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19398,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19398=1,IF(F19398=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T1009",null,"Child sitting services",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19408,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19408,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19408=1,IF(F19408=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19427,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19427,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19427=1,IF(F19427=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19451,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19451,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19451=1,IF(F19451=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19463,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19463,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19463=1,IF(F19463=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19464,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19464,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19464=1,IF(F19464=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19465,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19465,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A19465=1,IF(F19465=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A19465=1,IF(F19465=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19466,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19466,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19466=1,IF(F19466=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T2044",null,"Hospice respite care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19467,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19467,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19467=1,IF(F19467=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T2045",null,"Hospice general care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19468,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19468,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19468=1,IF(F19468=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19469,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19469,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19469=1,IF(F19469=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19470,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19470,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19470=1,IF(F19470=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19471,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19471,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19471=1,IF(F19471=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19472,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19472,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19472=1,IF(F19472=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19473,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19473,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19473=1,IF(F19473=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4521",null,"Adult size brief/diaper sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19474,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19474,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19474=1,IF(F19474=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4522",null,"Adult size brief/diaper med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19475,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19475,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19475=1,IF(F19475=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4523",null,"Adult size brief/diaper lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19476,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19476,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19476=1,IF(F19476=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4524",null,"Adult size brief/diaper xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19477,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19477,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19477=1,IF(F19477=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4525",null,"Adult size pull-on sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19478,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19478,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19478=1,IF(F19478=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4526",null,"Adult size pull-on med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19479,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19479,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19479=1,IF(F19479=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4527",null,"Adult size pull-on lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19480,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19480,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19480=1,IF(F19480=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4528",null,"Adult size pull-on xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19481,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19481,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19481=1,IF(F19481=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19482,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19482,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19482=1,IF(F19482=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19483,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19483,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19483=1,IF(F19483=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19484,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19484,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19484=1,IF(F19484=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19485,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19485,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19485=1,IF(F19485=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4533",null,"Youth size brief/diaper",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19486,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19486,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19486=1,IF(F19486=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4534",null,"Youth size pull-on",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19487,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19487,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19487=1,IF(F19487=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4535",null,"Disposable liner/shield/pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19488,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19488,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19488=1,IF(F19488=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4536",null,"Reusable pull-on any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19489,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19489,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19489=1,IF(F19489=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4537",null,"Reusable underpad bed size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19490,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19490,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19490=1,IF(F19490=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19491,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19491,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19491=1,IF(F19491=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4539",null,"Reuse diaper/brief any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19492,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19492,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19492=1,IF(F19492=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4540",null,"Reusable underpad chair size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19493,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19493,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19493=1,IF(F19493=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4541",null,"Large disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19494,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19494,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19494=1,IF(F19494=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4542",null,"Small disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19495,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19495,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19495=1,IF(F19495=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19496,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19496,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19496=1,IF(F19496=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4544",null,"Adlt disp und/pull on abv xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19497,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19497,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19497=1,IF(F19497=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T4545",null,"Incon disposable penile wrap",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19498,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19498,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19498=1,IF(F19498=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19499,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19499,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19499=1,IF(F19499=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"T5999",null,"Supply, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19500,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19500,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19500=1,IF(F19500=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"U0001",null,"2019-ncov diagnostic p",null,37.712394719999999,null,37.712394719999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19501,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19501,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19501=1,IF(F19501=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"U0002",null,"Covid-19 lab test non-cdc",null,53.885351520000007,null,53.885351520000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19502,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19502,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19502=1,IF(F19502=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"U0003",null,"SARS-COV-2 DNA/RNA HIGH THROUGHPUT",null,106.5,null,106.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19503,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19503,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19503=1,IF(F19503=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"U0004",null,"2019-NCOV ANY TECHNIQUE HIGH THROUGHPUT",null,106.5,null,106.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19504,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19504,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19504=1,IF(F19504=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"U0005",null,"Infec agen detec ampli probe",null,35.5,null,35.5,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19505,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19505,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19505=1,IF(F19505=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19506,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19506,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19506=1,IF(F19506=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19507,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19507,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19507=1,IF(F19507=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2020",null,"Vision svcs frames purchases",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19508,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19508,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19508=1,IF(F19508=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2025",null,"Eyeglasses delux frames",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19509,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19509,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19509=1,IF(F19509=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2100",null,"Lens spher single plano 4.00",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19510,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19510,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19510=1,IF(F19510=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2101",null,"Single visn sphere 4.12-7.00",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19511,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19511,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19511=1,IF(F19511=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2102",null,"Singl visn sphere 7.12-20.00",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19512,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19512,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19512=1,IF(F19512=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2103",null,"Spherocylindr 4.00d/12-2.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19513,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19513,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19513=1,IF(F19513=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2104",null,"Spherocylindr 4.00d/2.12-4d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19514,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19514,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19514=1,IF(F19514=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2105",null,"Spherocylinder 4.00d/4.25-6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19515,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19515,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19515=1,IF(F19515=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2106",null,"Spherocylinder 4.00d/>6.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19516,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19516,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19516=1,IF(F19516=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2107",null,"Spherocylinder 4.25d/12-2d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19517,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19517,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19517=1,IF(F19517=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2108",null,"Spherocylinder 4.25d/2.12-4d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19518,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19518,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19518=1,IF(F19518=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2109",null,"Spherocylinder 4.25d/4.25-6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19519,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19519,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19519=1,IF(F19519=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2110",null,"Spherocylinder 4.25d/over 6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19520,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19520,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19520=1,IF(F19520=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2111",null,"Spherocylindr 7.25d/.25-2.25",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19521,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19521,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19521=1,IF(F19521=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2112",null,"Spherocylindr 7.25d/2.25-4d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19522,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19522,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19522=1,IF(F19522=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2113",null,"Spherocylindr 7.25d/4.25-6d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19523,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19523,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19523=1,IF(F19523=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2114",null,"Spherocylinder over 12.00d",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
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[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19607,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19607,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19607=1,IF(F19607=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2730",null,"Special base curve",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19608,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19608,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19608=1,IF(F19608=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2744",null,"Tint photochromatic lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19609,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19609,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19609=1,IF(F19609=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2745",null,"Tint, any color/solid/grad",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19610,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19610,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19610=1,IF(F19610=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2750",null,"Anti-reflective coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19611,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19611,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19611=1,IF(F19611=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2755",null,"Uv lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19612,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19612,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19612=1,IF(F19612=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2756",null,"Eye glass case",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19613,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19613,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19613=1,IF(F19613=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2760",null,"Scratch resistant coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19614,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19614,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19614=1,IF(F19614=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2761",null,"Mirror coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19615,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19615,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19615=1,IF(F19615=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2762",null,"Polarization, any lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19616,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19616,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19616=1,IF(F19616=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2770",null,"Occluder lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19617,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19617,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19617=1,IF(F19617=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2780",null,"Oversize lens/es",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19618,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19618,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19618=1,IF(F19618=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19619,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19619,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19619=1,IF(F19619=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2782",null,"Lens, 1.54-1.65 p/1.60-1.79g",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19620,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19620,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19620=1,IF(F19620=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2783",null,"Lens, >= 1.66 p/>=1.80 g",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19621,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19621,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19621=1,IF(F19621=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2784",null,"Lens polycarb or equal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19622,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19622,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19622=1,IF(F19622=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2785",null,"Corneal tissue processing",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19623,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19623,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19623=1,IF(F19623=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2786",null,"Occupational multifocal lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19624,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19624,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19624=1,IF(F19624=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2787",null,"Astigmatism-correct function",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19625,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19625,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19625=1,IF(F19625=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2788",null,"Presbyopia-correct function",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19626,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19626,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19626=1,IF(F19626=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2790",null,"Amniotic membrane",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19627,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19627,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19627=1,IF(F19627=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19628,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19628,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19628=1,IF(F19628=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V2799",null,"Misc vision item or service",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19629,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19629,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19629=1,IF(F19629=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5008",null,"Hearing screening",null,87.300307016207981,null,87.300307016207981,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19630,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19630,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19630=1,IF(F19630=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5010",null,"Assessment for hearing aid",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19631,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19631,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19631=1,IF(F19631=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5011",null,"Hearing aid fitting/checking",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19632,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19632,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19632=1,IF(F19632=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5014",null,"Hearing aid repair/modifying",null,58.203775680336001,null,58.203775680336001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19633,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19633,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19633=1,IF(F19633=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5020",null,"Conformity evaluation",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"B"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19634,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19634,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19634=1,IF(F19634=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5030",null,"Body-worn hearing aid air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19635,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19635,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19635=1,IF(F19635=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5040",null,"Body-worn hearing aid bone",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19636,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19636,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19636=1,IF(F19636=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5050",null,"Hearing aid monaural in ear",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19637,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19637,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19637=1,IF(F19637=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5060",null,"Behind ear hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19638,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19638,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19638=1,IF(F19638=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5070",null,"Glasses air conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19639,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19639,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19639=1,IF(F19639=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5080",null,"Glasses bone conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19640,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19640,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19640=1,IF(F19640=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19641,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19641,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19641=1,IF(F19641=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19642,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19642,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19642=1,IF(F19642=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5100",null,"Body-worn bilat hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19643,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19643,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19643=1,IF(F19643=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19644,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19644,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19644=1,IF(F19644=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5120",null,"Body-worn binaur hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19645,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19645,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19645=1,IF(F19645=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5130",null,"In ear binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19646,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19646,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19646=1,IF(F19646=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5140",null,"Behind ear binaur hearing ai",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19647,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19647,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19647=1,IF(F19647=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5150",null,"Glasses binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19648,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19648,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19648=1,IF(F19648=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5160",null,"Dispensing fee binaural",null,1652.9529476940481,null,1652.9529476940481,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19649,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19649,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19649=1,IF(F19649=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5171",null,"Hearing aid monaural ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19650,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19650,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19650=1,IF(F19650=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5172",null,"Hearing aid monaural itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19651,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19651,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19651=1,IF(F19651=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5181",null,"Hearing aid monaural bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19652,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19652,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19652=1,IF(F19652=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5190",null,"Hearing aid monaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19653,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19653,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19653=1,IF(F19653=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5200",null,"Disp fee contralateral monau",null,990.73903458816005,null,990.73903458816005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19654,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19654,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19654=1,IF(F19654=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5211",null,"Hearing aid binaural ite/ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19655,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19655,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19655=1,IF(F19655=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5212",null,"Hearing aid binaural ite/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19656,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19656,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19656=1,IF(F19656=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5213",null,"Hearing aid binaural ite/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19657,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19657,1)","v":{"$error":"#VALUE!"}},{"$f":"IF(A19657=1,IF(F19657=\"\",1,0))","v":{"$error":"#VALUE!"}},{"$f":"IF(A19657=1,IF(F19657=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5214",null,"Hearing aid binaural itc/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19658,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19658,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19658=1,IF(F19658=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5215",null,"Hearing aid binaural itc/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19659,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19659,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19659=1,IF(F19659=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5221",null,"Hearing aid binaural bte/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19660,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19660,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19660=1,IF(F19660=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5230",null,"Hearing aid binaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19661,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19661,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19661=1,IF(F19661=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5240",null,"Disp fee contralateral binau",null,990.73903458816005,null,990.73903458816005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19662,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19662,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19662=1,IF(F19662=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5241",null,"Dispensing fee, monaural",null,826.47647384702407,null,826.47647384702407,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19663,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19663,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19663=1,IF(F19663=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5242",null,"Hearing aid, monaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19664,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19664,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19664=1,IF(F19664=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5243",null,"Hearing aid, monaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19665,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19665,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19665=1,IF(F19665=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5244",null,"Hearing aid, prog, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19666,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19666,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19666=1,IF(F19666=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5245",null,"Hearing aid, prog, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19667,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19667,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19667=1,IF(F19667=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5246",null,"Hearing aid, prog, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19668,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19668,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19668=1,IF(F19668=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5247",null,"Hearing aid, prog, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19669,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19669,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19669=1,IF(F19669=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5248",null,"Hearing aid, binaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19670,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19670,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19670=1,IF(F19670=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5249",null,"Hearing aid, binaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19671,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19671,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19671=1,IF(F19671=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5250",null,"Hearing aid, prog, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19672,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19672,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19672=1,IF(F19672=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5251",null,"Hearing aid, prog, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19673,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19673,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19673=1,IF(F19673=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5252",null,"Hearing aid, prog, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19674,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19674,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19674=1,IF(F19674=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5253",null,"Hearing aid, prog, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19675,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19675,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19675=1,IF(F19675=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5254",null,"Hearing id, digit, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19676,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19676,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19676=1,IF(F19676=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5255",null,"Hearing aid, digit, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19677,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19677,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19677=1,IF(F19677=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5256",null,"Hearing aid, digit, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19678,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19678,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19678=1,IF(F19678=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5257",null,"Hearing aid, digit, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19679,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19679,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19679=1,IF(F19679=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5258",null,"Hearing aid, digit, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19680,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19680,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19680=1,IF(F19680=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5259",null,"Hearing aid, digit, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19681,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19681,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19681=1,IF(F19681=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5260",null,"Hearing aid, digit, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19682,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19682,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19682=1,IF(F19682=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5261",null,"Hearing aid, digit, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19683,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19683,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19683=1,IF(F19683=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19684,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19684,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19684=1,IF(F19684=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19685,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19685,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19685=1,IF(F19685=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5264",null,"Ear mold/insert",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19686,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19686,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19686=1,IF(F19686=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19687,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19687,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19687=1,IF(F19687=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5266",null,"Battery for hearing device",null,1.0177358162400001,null,1.0177358162400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19688,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19688,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19688=1,IF(F19688=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5267",null,"Hearing aid sup/access/dev",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19689,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19689,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19689=1,IF(F19689=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5268",null,"Ald telephone amplifier",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19690,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19690,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19690=1,IF(F19690=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19691,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19691,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19691=1,IF(F19691=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19692,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19692,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19692=1,IF(F19692=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19693,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19693,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19693=1,IF(F19693=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5272",null,"Tdd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19694,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19694,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19694=1,IF(F19694=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19695,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19695,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19695=1,IF(F19695=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5274",null,"Ald unspecified",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19696,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19696,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19696=1,IF(F19696=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5275",null,"Ear impression",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19697,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19697,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19697=1,IF(F19697=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19698,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19698,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19698=1,IF(F19698=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19699,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19699,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19699=1,IF(F19699=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19700,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19700,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19700=1,IF(F19700=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19701,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19701,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19701=1,IF(F19701=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19702,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19702,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19702=1,IF(F19702=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19703,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19703,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19703=1,IF(F19703=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19704,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19704,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19704=1,IF(F19704=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19705,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19705,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19705=1,IF(F19705=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"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"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19706,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19706,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19706=1,IF(F19706=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5290",null,"Ald transmitter microphone",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19707,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19707,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19707=1,IF(F19707=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5298",null,"Hearing aid noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19708,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19708,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19708=1,IF(F19708=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5299",null,"Hearing service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19709,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19709,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19709=1,IF(F19709=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5336",null,"Repair communication device",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19710,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19710,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19710=1,IF(F19710=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5362",null,"Speech screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19711,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19711,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19711=1,IF(F19711=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5363",null,"Language screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[{"$f":"SEARCH(Lookup!$A$12,'2021 Professional Fee Schedule'!E19712,1)","v":{"$error":"#VALUE!"}},{"$f":"SEARCH(Lookup!$A$13,'2021 Professional Fee Schedule'!F19712,1)","v":{"$error":"#VALUE!"}},{"$error":"#VALUE!"},{"$f":"IF(A19712=1,IF(F19712=Lookup!$A$13,2))","v":{"$error":"#VALUE!"}},"V5364",null,"Dysphagia screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]

{"sheet":"Updates and Corrections","index":4,"n_rows":68,"n_cols":4,"rows_kept":68,"cut":false,"hidden":false,"merged":[[0,0,0,2],[4,3,5,5]]}
["Updates and Corrections"]
["Posting date","Policy Area","Description"]
["2021-10-22","As applicable","A policy regarding students and student supervision​ is now available. Effective 10/25/21."]
["2021-09-13","As applicable","Certain chapters may incorrectly link to the old general provider billing manual. Effective 9/13/2021- a new version is available through this link: https://lni.wa.gov/forms-publications/F245-432-000.pdf"]
["2021-07-30","Language Access Services","9976M is available for tactile sign interpretation- retroactive to 7/1/2018. Payable only to tactile interpreters for the total cost of services rendered. Mileage isn't a covered service for tactile interpreters per updated policy beginning 10/1/2020.​","*Background query may take up to 20 seconds to complete."]
["2021-06-18","As applicable","Certain chapters may incorrectly list CPT code 99201 as an active code. Effective July 1, 2021, this code is no longer covered.​"]
[]
[]
["Posting date","Description","Updated Version"]
["2021-10-26","The Department is allowing coverage of the COVID-19 booster vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health at home. Prior authorization required","N/A"]
[null,"91306 effective 10/20/2021 $0.01"]
[null,"0064A effective 10/20/2021 $40.00"]
["09/29/2021​","We are in the process of installing APC Grouping software for 2021. Outpatient bill adjustments will occur once the software update is complete.","N/A"]
["2021-09-29","New HCPCS effective October 1, 2021 ","New and Deleted HCPCS October 2021​"]
[null,"Deleted HCPCS codes effective September 30, 2021"]
["2021-09-29","The Department is allowing coverage of the COVID-19 booster vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health at home. Prior authorization required.​","N/A"]
[null,"0004A effective 9/22/2021 $40.00​"]
["2021-09-08","The following COVID-19 related codes have been updated. Prior authorization is no longer required for patients who are in an outpatient setting -type of service X- for the following codes: ","N/A"]
[null,"M0243 - effective 5/6/21"]
[null,"M0245 - effective 4/1/21"]
[null,"M0247 - effective 5/26/21"]
[null,"M0249 - effective 6/24/21"]
[null,"M0250 - effective 6/24/21"]
["2021-09-08","The Department is allowing the coverage of the COVID-19 vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health are home. Prior authorization is required- except for M0240 when performed in an outpatient setting. ","N/A"]
[null,"Q0240 - effective 7/30/2021 - $0.00"]
[null,"M0240 - effective 7/30/2021 - $450.00"]
[null,"M0241 - effective 7/30/2021 - $750.00"]
[null,"0013A - effective 8/12/2021 - $40.00 "]
[null,"0003A - effective 8/12/2021 - $40.00"]
["2021-06-24","New HCPCS and Deleted HCPCS codes. See file for effective dates.​","New and Deleted HCPCS July 2021​​"]
[]
[]
["Posting date","Policy Area","Description"]
["2021-09-29","Chapter 17: Mental Health Services​","Page 6 of Chapter 17: Mental Health Services links to the Authorization and Reporting Requirements for Mental Health Specialists. This form will undergo updates in the near future. For the most up to date form and information- visit our Mental Health Services page. In addition- on page 3 of the same policy- RCW 51.08.142 should also be referenced in addition to WAC 296-21-270 and 296-14-300.​"]
["2021-08-11","Chapter 23: Pathology and Laboratory Services","Page 8 of Chapter 23: Pathology and Laboratory Services incorrectly lists G6058 -Drug confirmation- each procedure- as a covered service for drug screening. This is a non-covered code. This section should read as follows: The department will pay for drug screening using the following billing codes: For presumptive testing billing codes 80305- 80306- or 80307- or For definitive testing HCPCS codes G0480- G0481- G0482- or G0483. G0480-G0483 requires prior authorization. ​"]
["2021-06-18","Chapter 17: Mental Health Services","Page 10 of Chapter 17: Mental Health Services incorrectly lists only 90837 as billable with CPT codes 99354, 99355, 99356, and 99357. The statement should read as follows: Use the appropriate prolonged services codes (99354, 99355, 99356, 99357) with either 90837 for psychotherapy or 90847 for family psychotherapy, for face to face services with the patient, not performed with E/M services. See Chapter 10: Evaluation and Management (E/M) Services for additional details on prolonged services.​"]
[]
[]
["Posting date","Description","Updated Version"]
["2021-08-26","An error has been identified in the Professional Services Fee Schedule. The following codes should have appeared on the 2021 fee schedule with prior authorization required- through the claim manager:","N/A"]
[null,"1045M"]
[null,"1098M"]
["2021-08-16","An error has been identified in the Professional Services Fee Schedule. The following codes should have appeared on the 2021 fee schedule with corresponding values: ","N/A"]
[]
[null,"E0660-NU $189.69"]
[null,"E0665-NU $150.61"]
[null,"E0666-NU $163.97"]
[null,"E0667-NU $384.43"]
[]
["2021-08-03","Fees for pharmacy and DME suppliers are available in the excel file titled Medical and Surgical Supply Codes. Per chapter 9- these providers may receive reimbursement for these codes because they're not bundled into a service. These fees are effective as of July 1, 2021. ​","Medical and Surgical Supply Codes​​"]
["2021-07-19","The following COVID-19 related codes have been updated. The Department is allowing the coverage of the COVID-19 vaccine for immunocompromised workers who reside in a nursing home- group home- skilled nursing facility- or are receiving home health are home. Prior authorization is required. The Department has updated its fees for the following codes: ","N/A"]
[]
[null,"M0245-effective 4/1/2021- $450.00"]
[null,"Q0244-effective 6/3/2021- $0.00 "]
[]
["2021-07-12","An error has been identified in the Professional Services Fee Schedule. 1158M should have appeared with prior authorization Y-CM. This code is covered effective 07/01/2021.​","N/A"]
["2021-07-06","An error has been identified in the Professional Services Fee Schedule. 99417 should have appeared as fee schedule indicator R- not X. This code is covered effective 07/01/2021​.","N/A"]
["2021-06-28","An error has been identified on the Anesthesia fee schedule. The following codes should have appeared on the 2021 Anesthesia fee schedule with corresponding values:","N/A"]
[null,"00731 - Anesthesia Base 5"]
[null,"00732 - Anesthesia Base 6"]
[null,"00811 - Anesthesia Base 4"]
[null,"00812 - Anesthesia Base 3"]
[null,"00813 - Anesthesia Base 5"]
[null,"These codes have been effective since 1/1/2018."]
["2021-06-28","An error has been identified in the Professional Services Fee Schedule. Effective 03/15/2021 0001A is priced at $40.00. ​","N/A"]
["2021-06-28","Effective Date 07/01/2021","APR DRG Assignment CSV 2021 Cover and Key​"]
[null,"Revised and Corrected APR DRG v38 Assignment Sheets","APR DRG Assignment CSV 2021 REVISED​"]
[null,null,"APR DRG Assignment Excel 2021 REVISED​"]

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[null,"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"]
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["Professional Services Fee Schedule"]
[]
[]
[]
[null,null,null,"DOLLAR VALUE",null,null,"MODIFIERS"]
["CODE","Modifiers","Short Description (HCPCS and Local Only)","NON-FACILITY SETTING","FACILITY SETTING","FOL UP","PRE OP\n(-56)","INTRA OP\n(-54)","POST OP\n(-55)","PCTC\n(26/TC)","MSI\n(-51)","BSI\n(-50)","ASI\n(-80)","CSI\n(-62)","TSI\n(-66)","ENDO\nBASE","FSI","LIC REQ","Prior Auth","MARFS Chapters","MARFS Chapters","MARFS Chapters"]
[10004,null,"See CPT",89.165999999999997,73.533000000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10005,null,"See CPT",242.02199999999999,122.748,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10006,null,"See CPT",105.378,85.691999999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10007,null,"See CPT",562.20900000000006,155.751,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10008,null,"See CPT",297.02699999999999,99.587999999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10009,null,"See CPT",863.28899999999999,189.91199999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10010,null,"See CPT",505.46699999999998,136.64399999999998,"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",1208.373,229.863,"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",206.70299999999997,88.007999999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10060,null,"See CPT",219.441,180.648,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10061,null,"See CPT",372.87600000000003,317.87099999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10080,null,"See CPT",450.46199999999999,185.28,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10081,null,"See CPT",613.74,299.92199999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10120,null,"See CPT",275.60399999999998,182.964,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10121,null,"See CPT",481.72800000000001,319.60799999999995,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10140,null,"See CPT",305.13299999999998,206.124,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10160,null,"See CPT",231.6,165.01500000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10180,null,"See CPT",469.56899999999996,309.76499999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11000,null,"See CPT",102.483,46.899000000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11001,null,"See CPT",44.003999999999998,23.16,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11004,null,"See CPT",974.45699999999988,974.45699999999988,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11005,null,"See CPT",1318.383,1318.383,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11006,null,"See CPT",1195.635,1195.635,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11008,null,"See CPT",464.35799999999995,464.35799999999995,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11010,null,"See CPT",839.55,471.88499999999999,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R",null,null,2,29]
[11011,null,"See CPT",925.82100000000003,509.52000000000004,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11012,null,"See CPT",1180.5809999999999,709.27499999999998,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11042,null,"See CPT",233.916,103.64100000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11043,null,"See CPT",416.30099999999999,264.60300000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11044,null,"See CPT",545.99699999999996,383.298,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11045,null,"See CPT",72.375,44.003999999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11046,null,"See CPT",127.95899999999999,93.798000000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11047,null,"See CPT",210.756,165.01500000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11055,null,"See CPT",125.64299999999999,26.634,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11056,null,"See CPT",143.59199999999998,37.634999999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11057,null,"See CPT",157.488,49.214999999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11102,null,"See CPT",187.017,64.269000000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11103,null,"See CPT",93.798000000000002,37.055999999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11104,null,"See CPT",232.17899999999997,79.901999999999987,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11105,null,"See CPT",108.27300000000001,44.003999999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11106,null,"See CPT",284.86799999999999,97.271999999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11107,null,"See CPT",130.27500000000001,53.268000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11200,null,"See CPT",159.80399999999997,131.43299999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11201,null,"See CPT",31.266000000000002,27.791999999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11300,null,"See CPT",186.43800000000002,57.9,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11301,null,"See CPT",222.33599999999998,86.85,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11302,null,"See CPT",253.60199999999998,101.325,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11303,null,"See CPT",278.49899999999997,119.85299999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11305,null,"See CPT",194.54399999999998,64.847999999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11306,null,"See CPT",224.07300000000001,83.954999999999998,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11307,null,"See CPT",258.23399999999998,107.694,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11308,null,"See CPT",273.28799999999995,121.011,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11310,null,"See CPT",213.072,77.585999999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11311,null,"See CPT",249.54899999999998,106.536,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11312,null,"See CPT",284.28899999999999,125.64299999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11313,null,"See CPT",329.45100000000002,163.27799999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11400,null,"See CPT",232.17899999999997,145.32899999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11401,null,"See CPT",279.65699999999998,182.38499999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11402,null,"See CPT",307.44899999999996,199.755,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11403,null,"See CPT",353.76900000000001,257.07600000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11404,null,"See CPT",402.40499999999997,283.13099999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11406,null,"See CPT",565.68299999999999,426.72300000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11420,null,"See CPT",231.6,143.01300000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11421,null,"See CPT",287.18399999999997,188.75399999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11422,null,"See CPT",322.50299999999999,235.07399999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11423,null,"See CPT",366.50700000000001,269.81400000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11424,null,"See CPT",419.19600000000003,306.291,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11426,null,"See CPT",595.21199999999999,473.04300000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11440,null,"See CPT",258.23399999999998,183.54299999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11441,null,"See CPT",311.50200000000001,228.126,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11442,null,"See CPT",344.505,252.44400000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11443,null,"See CPT",407.03699999999998,308.02800000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11444,null,"See CPT",504.88800000000003,389.66700000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11446,null,"See CPT",686.69399999999996,554.68200000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11450,null,"See CPT",775.28100000000006,451.041,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11451,null,"See CPT",946.66500000000008,569.73599999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11462,null,"See CPT",750.38400000000001,427.30199999999996,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11463,null,"See CPT",957.66599999999994,572.05200000000002,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11470,null,"See CPT",814.07399999999996,492.72899999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11471,null,"See CPT",977.93100000000004,604.476,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[11600,null,"See CPT",360.71700000000004,211.91400000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11601,null,"See CPT",411.66899999999998,255.339,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11602,null,"See CPT",438.303,275.60399999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11603,null,"See CPT",496.20300000000003,328.87199999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11604,null,"See CPT",553.524,363.03299999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11606,null,"See CPT",789.17700000000002,541.36500000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11620,null,"See CPT",361.875,213.072,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11621,null,"See CPT",412.827,255.91799999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11622,null,"See CPT",452.77800000000002,289.5,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11623,null,"See CPT",526.89,357.822,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11624,null,"See CPT",600.42299999999989,407.61599999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11626,null,"See CPT",722.59199999999998,500.83500000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11640,null,"See CPT",369.40199999999999,218.28299999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11641,null,"See CPT",426.72300000000001,266.33999999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11642,null,"See CPT",478.83299999999997,310.923,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11643,null,"See CPT",562.20900000000006,389.66700000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11644,null,"See CPT",690.74699999999996,483.46499999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11646,null,"See CPT",893.976,669.90300000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11719,null,"See CPT",24.317999999999998,12.738,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11720,null,"See CPT",57.320999999999998,24.317999999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11721,null,"See CPT",78.165000000000006,41.108999999999995,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11730,null,"See CPT",207.86099999999999,91.481999999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11732,null,"See CPT",59.637,28.95,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11740,null,"See CPT",100.746,54.425999999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11750,null,"See CPT",287.76299999999998,175.43699999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11755,null,"See CPT",225.23099999999999,103.64100000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11760,null,"See CPT",347.97899999999998,196.85999999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11762,null,"See CPT",526.89,327.13499999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11765,null,"See CPT",304.55399999999997,160.38300000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11770,null,"See CPT",627.05700000000002,322.50299999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11771,null,"See CPT",1116.3120000000001,774.702,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11772,null,"See CPT",1378.02,1024.83,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11900,null,"See CPT",99.587999999999994,50.372999999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11901,null,"See CPT",122.16899999999998,77.585999999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11920,null,"See CPT",344.505,189.333,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11921,null,"See CPT",388.50900000000001,222.91499999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11922,null,"See CPT",106.536,49.214999999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11950,null,"See CPT",139.53900000000002,88.007999999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11951,null,"See CPT",186.43800000000002,125.06400000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11952,null,"See CPT",249.54899999999998,175.43699999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11954,null,"See CPT",274.44600000000003,191.649,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11960,null,"See CPT",1783.8989999999999,1783.8989999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11970,null,"See CPT",971.56200000000001,971.56200000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11971,null,"See CPT",950.13900000000001,950.13900000000001,"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",182.38499999999999,108.27300000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11982,null,"See CPT",206.70299999999997,127.95899999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11983,null,"See CPT",254.76000000000002,177.17400000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12001,null,"See CPT",169.64699999999999,75.849000000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12002,null,"See CPT",203.22899999999998,100.746,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12004,null,"See CPT",235.65300000000002,125.06400000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12005,null,"See CPT",313.23899999999998,162.11999999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12006,null,"See CPT",365.928,199.17599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12007,null,"See CPT",412.24799999999999,247.23299999999998,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[12011,null,"See CPT",203.22899999999998,94.955999999999989,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12013,null,"See CPT",210.756,99.009,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12014,null,"See CPT",255.91799999999998,126.80099999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12015,null,"See CPT",307.44899999999996,159.80399999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12016,null,"See CPT",390.24599999999998,218.28299999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12017,null,"See CPT",258.81299999999999,258.81299999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12018,null,"See CPT",292.97399999999999,292.97399999999999,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[12020,null,"See CPT",539.62800000000004,325.39800000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12021,null,"See CPT",310.923,244.33799999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12031,null,"See CPT",473.04300000000001,259.971,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12032,null,"See CPT",548.31299999999999,325.39800000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12034,null,"See CPT",597.52800000000002,352.03199999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12035,null,"See CPT",707.53800000000001,415.14299999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12036,null,"See CPT",777.59699999999998,487.51799999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12037,null,"See CPT",866.76300000000003,563.36699999999996,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R",null,null,2,29]
[12041,null,"See CPT",475.93800000000005,250.12800000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12042,null,"See CPT",552.36599999999999,335.24099999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12044,null,"See CPT",686.69399999999996,366.50700000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12045,null,"See CPT",736.48800000000006,469.56899999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12046,null,"See CPT",905.55600000000004,549.471,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12047,null,"See CPT",987.19500000000005,610.84500000000003,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[12051,null,"See CPT",509.52000000000004,291.23700000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12052,null,"See CPT",561.63,341.61,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12053,null,"See CPT",657.16499999999996,367.08599999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12054,null,"See CPT",697.11599999999999,375.77100000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12055,null,"See CPT",914.24099999999987,517.04700000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12056,null,"See CPT",1039.3049999999998,662.95499999999993,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12057,null,"See CPT",1098.3629999999998,725.48699999999997,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[13100,null,"See CPT",618.37199999999996,344.505,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13101,null,"See CPT",720.27599999999995,428.46000000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13102,null,"See CPT",210.17699999999999,122.16899999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13120,null,"See CPT",642.68999999999994,402.98399999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13121,null,"See CPT",769.49099999999999,440.61900000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13122,null,"See CPT",228.126,140.11799999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13131,null,"See CPT",698.85299999999995,413.98500000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13132,null,"See CPT",847.65600000000006,516.46799999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13133,null,"See CPT",298.185,213.65099999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13151,null,"See CPT",759.64799999999991,477.096,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13152,null,"See CPT",892.23900000000003,573.21,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13153,null,"See CPT",328.87199999999996,233.33700000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13160,null,"See CPT",1376.2829999999999,1376.2829999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14000,null,"See CPT",1115.7329999999999,865.02599999999995,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14001,null,"See CPT",1415.076,1119.7860000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14020,null,"See CPT",1229.2170000000001,970.40400000000011,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14021,null,"See CPT",1510.6109999999999,1213.5840000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14040,null,"See CPT",1325.9099999999999,1069.413,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14041,null,"See CPT",1606.146,1302.75,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14060,null,"See CPT",1337.49,1138.3140000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14061,null,"See CPT",1731.789,1398.864,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14301,null,"See CPT",1900.278,1489.7670000000001,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[14302,null,"See CPT",368.24400000000003,368.24400000000003,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[14350,null,"See CPT",1171.896,1171.896,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15002,null,"See CPT",626.47799999999995,376.34999999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15003,null,"See CPT",126.80099999999999,77.007000000000005,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15004,null,"See CPT",710.43299999999999,447.56700000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15005,null,"See CPT",208.44,154.01400000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15040,null,"See CPT",489.83400000000006,213.072,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15050,null,"See CPT",1063.0439999999999,805.38900000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15100,null,"See CPT",1532.6129999999998,1235.0069999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15101,null,"See CPT",341.61,193.965,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15110,null,"See CPT",1438.8150000000001,1206.636,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15111,null,"See CPT",192.80699999999999,172.542,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15115,null,"See CPT",1417.9709999999998,1192.74,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15116,null,"See CPT",282.55199999999996,255.339,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15120,null,"See CPT",1496.136,1191.5819999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15121,null,"See CPT",381.56099999999998,233.916,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15130,null,"See CPT",1280.1689999999999,1034.0940000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15131,null,"See CPT",167.91,153.435,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15135,null,"See CPT",1547.088,1309.6980000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15136,null,"See CPT",165.59399999999999,153.435,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15150,null,"See CPT",1241.376,1106.4690000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15151,null,"See CPT",203.80799999999999,186.43800000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15152,null,"See CPT",250.12800000000001,233.33700000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15155,null,"See CPT",1393.0739999999998,1259.904,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15156,null,"See CPT",273.28799999999995,255.91799999999998,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15157,null,"See CPT",303.97499999999997,279.07800000000003,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15200,null,"See CPT",1477.6079999999999,1159.1579999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15201,null,"See CPT",260.55,130.85399999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15220,null,"See CPT",1356.597,1050.306,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15221,null,"See CPT",241.44299999999998,118.116,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15240,null,"See CPT",1629.885,1368.1769999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15241,null,"See CPT",314.976,180.648,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15260,null,"See CPT",1742.79,1448.6579999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15261,null,"See CPT",369.98099999999999,233.916,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15271,null,"See CPT",275.60399999999998,143.59199999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15272,null,"See CPT",45.161999999999999,30.108000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15273,null,"See CPT",559.89300000000003,337.55700000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15274,null,"See CPT",147.066,76.427999999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15275,null,"See CPT",283.13099999999997,159.80399999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15276,null,"See CPT",57.320999999999998,43.424999999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15277,null,"See CPT",612.00300000000004,383.87700000000001,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[15278,null,"See CPT",170.226,95.534999999999997,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15570,null,"See CPT",1605.567,1262.22,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15572,null,"See CPT",1547.088,1272.6420000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15574,null,"See CPT",1542.4559999999999,1269.7469999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15576,null,"See CPT",1390.1790000000001,1129.05,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15600,null,"See CPT",611.42399999999998,369.40199999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15610,null,"See CPT",659.48099999999999,423.24899999999997,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15620,null,"See CPT",802.49399999999991,569.15700000000004,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15630,null,"See CPT",823.33799999999997,595.79099999999994,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15650,null,"See CPT",900.34500000000003,657.16499999999996,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15730,null,"See CPT",2660.5050000000001,1579.5119999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15731,null,"See CPT",1970.337,1728.3150000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15733,null,"See CPT",1786.7939999999999,1786.7939999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15734,null,"See CPT",2587.5509999999999,2587.5509999999999,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15736,null,"See CPT",2105.8229999999999,2105.8229999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15738,null,"See CPT",2211.201,2211.201,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15740,null,"See CPT",1765.95,1445.184,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15750,null,"See CPT",1611.9359999999999,1611.9359999999999,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15756,null,"See CPT",3955.7279999999996,3955.7279999999996,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15757,null,"See CPT",3945.8850000000002,3945.8850000000002,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15758,null,"See CPT",3944.7269999999999,3944.7269999999999,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15760,null,"See CPT",1492.662,1213.0049999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15769,null,"See CPT",836.65499999999997,836.65499999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[15770,null,"See CPT",1170.1590000000001,1170.1590000000001,"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",666.42899999999997,436.56599999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15776,null,"See CPT",904.39799999999991,598.10699999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15777,null,"See CPT",365.928,365.928,"000",0,0,0,0,0,1,1,0,0,null,"R",null,null,2,29]
[15780,null,"See CPT",1522.1909999999998,1146.9989999999998,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15781,null,"See CPT",972.72,748.06799999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15782,null,"See CPT",907.29300000000001,656.58600000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15783,null,"See CPT",803.07299999999998,610.26599999999996,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15786,null,"See CPT",429.03899999999999,229.28399999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[15787,null,"See CPT",65.426999999999992,29.529,"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",1010.934,892.23900000000003,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15821,null,"See CPT",1079.8349999999998,949.56,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15822,null,"See CPT",812.91599999999994,694.8,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15823,null,"See CPT",1085.0459999999998,953.03399999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15824,null,"See CPT",1530.5708246400002,1530.5708246400002,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15825,null,"See CPT",1316.0271009600001,1316.0271009600001,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15826,null,"See CPT",1244.4985238400002,1244.4985238400002,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15828,null,"See CPT",4262.7398299200013,4262.7398299200013,"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",2018.9729999999997,2018.9729999999997,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[15832,null,"See CPT",1584.723,1584.723,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[15833,null,"See CPT",1511.19,1511.19,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15834,null,"See CPT",1538.982,1538.982,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15835,null,"See CPT",1604.9879999999998,1604.9879999999998,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15836,null,"See CPT",1307.961,1307.961,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15837,null,"See CPT",1523.9279999999999,1240.2180000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15838,null,"See CPT",1120.365,1120.365,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15839,null,"See CPT",1571.4059999999999,1280.748,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15840,null,"See CPT",1767.1079999999999,1767.1079999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15841,null,"See CPT",3061.752,3061.752,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15842,null,"See CPT",4635.4740000000002,4635.4740000000002,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15845,null,"See CPT",1742.79,1742.79,"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]
[15850,null,"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[15851,null,"See CPT",195.702,78.165000000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15852,null,"See CPT",78.744,78.744,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15860,null,"See CPT",181.22699999999998,181.22699999999998,"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",1093.731,1093.731,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15922,null,"See CPT",1376.8620000000001,1376.8620000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15931,null,"See CPT",1220.5319999999999,1220.5319999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15933,null,"See CPT",1503.0840000000001,1503.0840000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15934,null,"See CPT",1638.57,1638.57,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15935,null,"See CPT",1993.4969999999998,1993.4969999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15936,null,"See CPT",1560.9839999999999,1560.9839999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15937,null,"See CPT",1804.7430000000002,1804.7430000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15940,null,"See CPT",1215.8999999999999,1215.8999999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15941,null,"See CPT",1607.883,1607.883,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15944,null,"See CPT",1591.0920000000001,1591.0920000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15945,null,"See CPT",1760.1599999999999,1760.1599999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15946,null,"See CPT",2788.4639999999999,2788.4639999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15950,null,"See CPT",1066.518,1066.518,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15951,null,"See CPT",1555.7729999999999,1555.7729999999999,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R",null,null,2,29]
[15952,null,"See CPT",1580.67,1580.67,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15953,null,"See CPT",1741.6319999999998,1741.6319999999998,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15956,null,"See CPT",2017.2360000000001,2017.2360000000001,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15958,null,"See CPT",2051.3969999999999,2051.3969999999999,"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",132.59100000000001,77.007000000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16020,null,"See CPT",152.85599999999999,95.534999999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16025,null,"See CPT",277.34100000000001,191.07,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16030,null,"See CPT",345.084,225.23099999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16035,null,"See CPT",330.60899999999998,330.60899999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16036,null,"See CPT",133.749,133.749,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[17000,null,"See CPT",117.53699999999999,94.376999999999995,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17003,null,"See CPT",12.158999999999999,3.4739999999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17004,null,"See CPT",292.97399999999999,166.75199999999998,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17106,null,"See CPT",601.58100000000002,471.88499999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17107,null,"See CPT",786.28200000000004,614.31899999999996,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17108,null,"See CPT",1104.732,896.29200000000003,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[17110,null,"See CPT",203.80799999999999,115.8,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17111,null,"See CPT",237.39,140.697,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17250,null,"See CPT",165.59399999999999,64.269000000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[17260,null,"See CPT",175.43699999999998,121.011,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17261,null,"See CPT",262.28700000000003,147.64499999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17262,null,"See CPT",314.976,187.017,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17263,null,"See CPT",341.03099999999995,207.86099999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17264,null,"See CPT",365.34899999999999,222.91499999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17266,null,"See CPT",415.14299999999997,261.12899999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17270,null,"See CPT",264.02399999999994,161.541,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17271,null,"See CPT",292.97399999999999,178.33199999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17272,null,"See CPT",332.92500000000001,206.124,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17273,null,"See CPT",368.82299999999998,233.33700000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17274,null,"See CPT",430.19699999999995,284.28899999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17276,null,"See CPT",497.93999999999994,341.61,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17280,null,"See CPT",248.96999999999997,147.64499999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17281,null,"See CPT",316.71299999999997,201.49199999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17282,null,"See CPT",362.45399999999995,232.75799999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17283,null,"See CPT",427.88099999999997,290.07900000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17284,null,"See CPT",486.36,338.13599999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17286,null,"See CPT",623.00400000000002,459.726,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17311,null,"See CPT",1192.1610000000001,603.31799999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17312,null,"See CPT",727.22400000000005,320.76600000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17313,null,"See CPT",1120.944,541.36500000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17314,null,"See CPT",696.53699999999992,298.185,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17315,null,"See CPT",134.32799999999997,84.533999999999992,"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",192.80699999999999,72.953999999999994,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19001,null,"See CPT",46.32,35.897999999999996,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19020,null,"See CPT",863.86799999999994,545.41800000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[19030,null,"See CPT",301.65899999999999,127.95899999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19081,null,"See CPT",1037.568,279.65699999999998,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19082,null,"See CPT",836.65499999999997,140.11799999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19083,null,"See CPT",1039.884,264.60300000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19084,null,"See CPT",822.18,130.85399999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19085,null,"See CPT",1604.4090000000001,305.71199999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19086,null,"See CPT",1278.4319999999998,152.27699999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19100,null,"See CPT",282.55199999999996,118.116,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19101,null,"See CPT",609.6869999999999,386.77199999999999,"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",893.976,613.74,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19112,null,"See CPT",847.077,562.20900000000006,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19120,null,"See CPT",910.18799999999999,722.01300000000003,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19125,null,"See CPT",1003.986,799.59900000000005,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19126,null,"See CPT",272.709,272.709,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM",2,29]
[19281,null,"See CPT",441.77699999999999,167.91,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19282,null,"See CPT",317.87099999999998,83.954999999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19283,null,"See CPT",488.67599999999993,169.64699999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19284,null,"See CPT",375.19200000000001,85.691999999999993,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19285,null,"See CPT",785.12400000000002,144.17100000000002,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19286,null,"See CPT",666.42899999999997,71.795999999999992,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19287,null,"See CPT",1350.2280000000001,214.809,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19288,null,"See CPT",1072.308,107.694,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19294,null,"See CPT",279.65699999999998,279.65699999999998,"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",1367.598,1367.598,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19318,null,"See CPT",1885.2240000000002,1885.2240000000002,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19325,null,"See CPT",1063.0439999999999,1063.0439999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19328,null,"See CPT",959.40300000000002,959.40300000000002,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19330,null,"See CPT",1115.7329999999999,1115.7329999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19340,null,"See CPT",1309.6980000000001,1309.6980000000001,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19342,null,"See CPT",1315.4879999999998,1315.4879999999998,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM",2,29]
[19350,null,"See CPT",1461.9749999999999,1162.6319999999998,"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",2023.0259999999998,2023.0259999999998,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19361,null,"See CPT",2683.0860000000002,2683.0860000000002,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19364,null,"See CPT",4681.7939999999999,4681.7939999999999,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19367,null,"See CPT",3045.54,3045.54,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19368,null,"See CPT",3734.5499999999997,3734.5499999999997,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19369,null,"See CPT",3469.9470000000001,3469.9470000000001,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19370,null,"See CPT",1159.1579999999999,1159.1579999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19371,null,"See CPT",1230.954,1230.954,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19380,null,"See CPT",1394.8109999999999,1394.8109999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19396,null,"See CPT",514.73099999999999,244.91700000000003,"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",1035.8309999999999,1035.8309999999999,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[20101,null,"See CPT",1099.521,363.03299999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20102,null,"See CPT",1138.3140000000001,439.46099999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20103,null,"See CPT",1032.357,594.63299999999992,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20150,null,"See CPT",1734.105,1734.105,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[20200,null,"See CPT",407.03699999999998,161.541,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20205,null,"See CPT",559.31399999999996,264.60300000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20206,null,"See CPT",440.61900000000003,97.850999999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20220,null,"See CPT",452.19899999999996,148.22399999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20225,null,"See CPT",748.06799999999998,221.178,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20240,null,"See CPT",243.75899999999999,243.75899999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20245,null,"See CPT",592.89599999999996,592.89599999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20250,null,"See CPT",677.43,677.43,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20251,null,"See CPT",739.96199999999999,739.96199999999999,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[20500,null,"See CPT",210.17699999999999,151.69800000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20501,null,"See CPT",265.18200000000002,63.690000000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20520,null,"See CPT",391.404,259.392,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20525,null,"See CPT",864.447,426.72300000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20526,null,"See CPT",141.27599999999998,97.850999999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20527,null,"See CPT",151.119,111.747,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20550,null,"See CPT",97.850999999999999,66.005999999999986,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20551,null,"See CPT",100.167,67.163999999999987,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20552,null,"See CPT",93.798000000000002,64.269000000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20553,null,"See CPT",108.85199999999999,73.533000000000001,"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",45.741,27.212999999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20561,null,"See CPT",67.163999999999987,41.687999999999995,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20600,null,"See CPT",90.323999999999998,60.216000000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20604,null,"See CPT",143.01300000000001,78.744,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20605,null,"See CPT",94.376999999999995,63.111000000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20606,null,"See CPT",156.33000000000001,89.745000000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20610,null,"See CPT",111.747,77.585999999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20611,null,"See CPT",174.279,101.904,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20612,null,"See CPT",111.16799999999999,70.637999999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20615,null,"See CPT",459.726,281.39400000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20650,null,"See CPT",387.351,274.44600000000003,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,null,2,29]
[20660,null,"See CPT",410.51099999999997,410.51099999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20661,null,"See CPT",891.66,891.66,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20662,null,"See CPT",904.97699999999998,904.97699999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20663,null,"See CPT",833.76,833.76,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[20664,null,"See CPT",1526.2439999999999,1526.2439999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20665,null,"See CPT",200.91300000000001,163.857,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20670,null,"See CPT",689.01,253.023,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20680,null,"See CPT",1091.9939999999999,727.22400000000005,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20690,null,"See CPT",1031.1989999999998,1031.1989999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20692,null,"See CPT",1937.3340000000001,1937.3340000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20693,null,"See CPT",772.38599999999997,772.38599999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20694,null,"See CPT",764.28,591.73800000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20696,null,"See CPT",2058.924,2058.924,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20697,null,"See CPT",3818.5050000000001,3818.5050000000001,"000",0,0,0,3,0,0,2,1,0,null,"R",null,null,2,29]
[20700,null,"See CPT",142.434,142.434,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20701,null,"See CPT",107.11500000000001,107.11500000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20702,null,"See CPT",237.39,237.39,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20703,null,"See CPT",170.80500000000001,170.80500000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20704,null,"See CPT",248.39099999999999,248.39099999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20705,null,"See CPT",204.38699999999997,204.38699999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20802,null,"See CPT",4715.9549999999999,4715.9549999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20805,null,"See CPT",5600.6670000000004,5600.6670000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20808,null,"See CPT",6754.6139999999996,6754.6139999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20816,null,"See CPT",3530.163,3530.163,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20822,null,"See CPT",3051.9090000000001,3051.9090000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20824,null,"See CPT",3537.1110000000003,3537.1110000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20827,null,"See CPT",3133.5479999999998,3133.5479999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20838,null,"See CPT",4790.6459999999997,4790.6459999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20900,null,"See CPT",735.32999999999993,313.81799999999998,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20902,null,"See CPT",476.517,476.517,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20910,null,"See CPT",829.12800000000004,829.12800000000004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20912,null,"See CPT",845.91899999999998,845.91899999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20920,null,"See CPT",702.327,702.327,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[20922,null,"See CPT",1074.0450000000001,851.70900000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20924,null,"See CPT",881.23800000000006,881.23800000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20930,null,"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[20931,null,"See CPT",187.596,187.596,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[20932,null,"See CPT",1290.5909999999999,1290.5909999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20933,null,"See CPT",1184.0549999999998,1184.0549999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20934,null,"See CPT",1289.433,1289.433,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20936,null,"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,29]
[20937,null,"See CPT",283.13099999999997,283.13099999999997,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20938,null,"See CPT",311.50200000000001,311.50200000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20939,null,"See CPT",117.53699999999999,117.53699999999999,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR",2,29]
[20950,null,"See CPT",496.20300000000003,152.27699999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[20955,null,"See CPT",4253.3339999999998,4253.3339999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20956,null,"See CPT",4535.8860000000004,4535.8860000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20957,null,"See CPT",4724.6399999999994,4724.6399999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20962,null,"See CPT",4586.8379999999997,4586.8379999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20969,null,"See CPT",4707.2699999999995,4707.2699999999995,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20970,null,"See CPT",4891.9709999999995,4891.9709999999995,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20972,null,"See CPT",4878.6540000000005,4878.6540000000005,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[20973,null,"See CPT",5150.7839999999997,5150.7839999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20974,null,"See CPT",143.01300000000001,86.271000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20975,null,"See CPT",302.81700000000001,302.81700000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[20979,null,"See CPT",95.534999999999997,53.847000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",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",248.39099999999999,248.39099999999999,"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",1285.9590000000001,1285.9590000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21011,null,"See CPT",667.58699999999999,451.041,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21012,null,"See CPT",590.57999999999993,590.57999999999993,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21013,null,"See CPT",957.66599999999994,698.85299999999995,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21014,null,"See CPT",909.60900000000004,909.60900000000004,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21015,null,"See CPT",1220.5319999999999,1220.5319999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",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",1406.97,1157.4209999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21026,null,"See CPT",969.24599999999987,759.64799999999991,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21029,null,"See CPT",1364.1239999999998,1080.9930000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[21030,null,"See CPT",846.49799999999993,647.322,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[21031,null,"See CPT",696.53699999999992,479.99099999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[21032,null,"See CPT",693.06299999999999,468.411,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21034,null,"See CPT",2325.2639999999997,1989.444,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21040,null,"See CPT",859.23599999999999,652.53300000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21044,null,"See CPT",1518.1379999999999,1518.1379999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21045,null,"See CPT",2100.6120000000001,2100.6120000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21046,null,"See CPT",1771.1610000000001,1771.1610000000001,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM",2,29]
[21047,null,"See CPT",2193.252,2193.252,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21048,null,"See CPT",1792.5840000000001,1792.5840000000001,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM",2,29]
[21049,null,"See CPT",2134.7729999999997,2134.7729999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21050,null,"See CPT",1519.875,1519.875,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21060,null,"See CPT",1375.125,1375.125,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21070,null,"See CPT",1085.0459999999998,1085.0459999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21073,null,"See CPT",674.53499999999997,431.35500000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21076,null,"See CPT",1508.8739999999998,1225.164,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21077,null,"See CPT",3683.0189999999998,3002.1149999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21079,null,"See CPT",2521.5449999999996,2021.2889999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21080,null,"See CPT",2917.5810000000001,2302.683,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21081,null,"See CPT",2689.4549999999999,2108.7179999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21082,null,"See CPT",2460.75,1917.069,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21083,null,"See CPT",2351.8979999999997,1779.8459999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21084,null,"See CPT",2685.402,2058.3449999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21085,null,"See CPT",1185.213,834.91800000000001,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21086,null,"See CPT",2745.6179999999999,2212.9380000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21087,null,"See CPT",2745.6179999999999,2212.9380000000001,"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",1158.579,621.846,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21110,null,"See CPT",1568.511,1294.0650000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21116,null,"See CPT",394.29899999999998,77.007000000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21120,null,"See CPT",1224.5849999999998,926.97900000000004,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[21121,null,"See CPT",1155.684,954.19200000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21122,null,"See CPT",1349.07,1349.07,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21123,null,"See CPT",1525.665,1525.665,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21125,null,"See CPT",5147.3100000000004,1169.58,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21127,null,"See CPT",7657.8539999999994,1340.385,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21137,null,"See CPT",1300.434,1300.434,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21138,null,"See CPT",1580.67,1580.67,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21139,null,"See CPT",1915.3319999999999,1915.3319999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21141,null,"See CPT",2311.9470000000001,2311.9470000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21142,null,"See CPT",2371.5839999999998,2371.5839999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21143,null,"See CPT",2455.5389999999998,2455.5389999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21145,null,"See CPT",2682.5070000000001,2682.5070000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21146,null,"See CPT",2801.7809999999999,2801.7809999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21147,null,"See CPT",2948.268,2948.268,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21150,null,"See CPT",2914.107,2914.107,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21151,null,"See CPT",3201.2909999999997,3201.2909999999997,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21154,null,"See CPT",3441.5759999999996,3441.5759999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21155,null,"See CPT",3810.3989999999999,3810.3989999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21159,null,"See CPT",4553.2560000000003,4553.2560000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21160,null,"See CPT",4933.6589999999997,4933.6589999999997,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21172,null,"See CPT",3628.0139999999997,3628.0139999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21175,null,"See CPT",3808.6619999999998,3808.6619999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21179,null,"See CPT",2621.1330000000003,2621.1330000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21180,null,"See CPT",2926.2660000000001,2926.2660000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21181,null,"See CPT",1281.327,1281.327,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[21182,null,"See CPT",3637.2779999999998,3637.2779999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21183,null,"See CPT",3956.3069999999998,3956.3069999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21184,null,"See CPT",4253.3339999999998,4253.3339999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21188,null,"See CPT",2790.78,2790.78,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21193,null,"See CPT",2133.6150000000002,2133.6150000000002,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM",2,29]
[21194,null,"See CPT",2466.54,2466.54,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM",2,29]
[21195,null,"See CPT",2377.3740000000003,2377.3740000000003,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM",2,29]
[21196,null,"See CPT",2446.8539999999998,2446.8539999999998,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM",2,29]
[21198,null,"See CPT",1874.2229999999997,1874.2229999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21199,null,"See CPT",1759.5809999999999,1759.5809999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21206,null,"See CPT",1730.0519999999999,1730.0519999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21208,null,"See CPT",3091.8599999999997,1291.17,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21209,null,"See CPT",1422.6030000000001,1061.3069999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21210,null,"See CPT",3449.6819999999998,1328.8049999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21215,null,"See CPT",7795.655999999999,1377.4409999999998,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21230,null,"See CPT",1308.54,1308.54,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21235,null,"See CPT",1308.54,990.66899999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21240,null,"See CPT",1824.4290000000001,1824.4290000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21242,null,"See CPT",1754.9489999999998,1754.9489999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21243,null,"See CPT",2785.569,2785.569,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21244,null,"See CPT",1797.2159999999999,1797.2159999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21245,null,"See CPT",2212.3589999999999,1668.0989999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21246,null,"See CPT",1471.818,1471.818,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21247,null,"See CPT",2736.3539999999998,2736.3539999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21248,null,"See CPT",1770.0029999999999,1392.4950000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21249,null,"See CPT",2389.5329999999999,1947.7560000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21255,null,"See CPT",2371.0050000000001,2371.0050000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21256,null,"See CPT",2138.826,2138.826,"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",1785.636,1291.17,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21275,null,"See CPT",1460.817,1460.817,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21280,null,"See CPT",1009.197,1009.197,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21282,null,"See CPT",687.85199999999998,687.85199999999998,"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]
[21310,null,"See CPT",243.18,46.32,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21315,null,"See CPT",530.36400000000003,275.02499999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21320,null,"See CPT",485.20200000000006,237.39,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21325,null,"See CPT",822.18,822.18,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21330,null,"See CPT",979.08899999999994,979.08899999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21335,null,"See CPT",1294.0650000000001,1294.0650000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21336,null,"See CPT",1176.528,1176.528,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21337,null,"See CPT",763.70099999999991,528.04799999999989,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21338,null,"See CPT",1230.954,1230.954,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21339,null,"See CPT",1384.3889999999999,1384.3889999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21340,null,"See CPT",1318.383,1318.383,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21343,null,"See CPT",1950.0719999999999,1950.0719999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21344,null,"See CPT",2463.0659999999998,2463.0659999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21345,null,"See CPT",1438.8150000000001,1121.5230000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21346,null,"See CPT",1845.2729999999999,1845.2729999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21347,null,"See CPT",1858.0110000000002,1858.0110000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21348,null,"See CPT",1911.8580000000002,1911.8580000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21355,null,"See CPT",809.44200000000001,578.42100000000005,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21356,null,"See CPT",912.50400000000002,664.11300000000006,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21360,null,"See CPT",920.61,920.61,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21365,null,"See CPT",1887.54,1887.54,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21366,null,"See CPT",2200.779,2200.779,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21385,null,"See CPT",1295.223,1295.223,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21386,null,"See CPT",1197.3719999999998,1197.3719999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21387,null,"See CPT",1350.8069999999998,1350.8069999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21390,null,"See CPT",1393.653,1393.653,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21395,null,"See CPT",1744.5269999999998,1744.5269999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21400,null,"See CPT",373.45499999999998,289.5,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21401,null,"See CPT",929.29500000000007,567.99900000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21406,null,"See CPT",1013.8290000000001,1013.8290000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21407,null,"See CPT",1115.7329999999999,1115.7329999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21408,null,"See CPT",1560.405,1560.405,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21421,null,"See CPT",1193.319,995.30100000000004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21422,null,"See CPT",1124.4180000000001,1124.4180000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21423,null,"See CPT",1405.8120000000001,1405.8120000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21431,null,"See CPT",1243.692,1243.692,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21432,null,"See CPT",1264.5360000000001,1264.5360000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21433,null,"See CPT",2983.0080000000003,2983.0080000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21435,null,"See CPT",2424.2729999999997,2424.2729999999997,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21436,null,"See CPT",3502.95,3502.95,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21440,null,"See CPT",1226.9010000000001,979.08899999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21445,null,"See CPT",1438.2359999999999,1148.1569999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21450,null,"See CPT",1087.941,875.44799999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21451,null,"See CPT",1406.3909999999998,1165.5269999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21452,null,"See CPT",1404.654,844.18200000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21453,null,"See CPT",1987.1279999999999,1681.9949999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21454,null,"See CPT",847.65600000000006,847.65600000000006,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[21461,null,"See CPT",3634.962,1906.6469999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21462,null,"See CPT",3939.5160000000001,2113.9289999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21465,null,"See CPT",1382.6519999999998,1382.6519999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21470,null,"See CPT",2013.7619999999999,2013.7619999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21480,null,"See CPT",249.54899999999998,53.268000000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21485,null,"See CPT",1773.4769999999999,1438.2359999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21490,null,"See CPT",1362.3869999999999,1362.3869999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21497,null,"See CPT",1296.9599999999998,1072.8869999999999,"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",883.55399999999997,583.053,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21502,null,"See CPT",882.97500000000002,882.97500000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21510,null,"See CPT",788.59799999999996,788.59799999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21550,null,"See CPT",493.88699999999994,273.28799999999995,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21552,null,"See CPT",774.702,774.702,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21554,null,"See CPT",1266.8519999999999,1266.8519999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21555,null,"See CPT",784.54500000000007,536.73299999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21556,null,"See CPT",928.13700000000006,928.13700000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21557,null,"See CPT",1655.3609999999999,1655.3609999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",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",971.56200000000001,971.56200000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21601,null,"See CPT",2023.605,2023.605,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21602,null,"See CPT",2745.0389999999998,2745.0389999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21603,null,"See CPT",2987.64,2987.64,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21610,null,"See CPT",2064.1349999999998,2064.1349999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21615,null,"See CPT",1051.4639999999999,1051.4639999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21616,null,"See CPT",1210.6890000000001,1210.6890000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21620,null,"See CPT",881.23800000000006,881.23800000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21627,null,"See CPT",943.77,943.77,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21630,null,"See CPT",2054.8710000000001,2054.8710000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21632,null,"See CPT",2080.9259999999999,2080.9259999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",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",606.21299999999997,606.21299999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21705,null,"See CPT",902.66099999999994,902.66099999999994,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21720,null,"See CPT",919.452,919.452,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21725,null,"See CPT",944.34899999999993,944.34899999999993,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21740,null,"See CPT",1754.9489999999998,1754.9489999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",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-CM",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-CM",2,29]
[21750,null,"See CPT",1161.4739999999999,1161.4739999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21811,null,"See CPT",1009.7760000000001,1009.7760000000001,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21812,null,"See CPT",1224.5849999999998,1224.5849999999998,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21813,null,"See CPT",1673.31,1673.31,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21820,null,"See CPT",265.18200000000002,260.55,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21825,null,"See CPT",948.98099999999999,948.98099999999999,"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",477.67500000000001,272.709,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21925,null,"See CPT",863.28899999999999,644.42700000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21930,null,"See CPT",895.71299999999997,632.84699999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21931,null,"See CPT",814.65300000000002,814.65300000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21932,null,"See CPT",1146.9989999999998,1146.9989999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21933,null,"See CPT",1274.9579999999999,1274.9579999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21935,null,"See CPT",1768.845,1768.845,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM",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",1673.8889999999999,1673.8889999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[22015,null,"See CPT",1641.4650000000001,1641.4650000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[22100,null,"See CPT",1498.452,1498.452,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22101,null,"See CPT",1503.663,1503.663,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22102,null,"See CPT",1439.394,1439.394,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22103,null,"See CPT",238.548,238.548,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22110,null,"See CPT",1816.9019999999998,1816.9019999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22112,null,"See CPT",1948.3349999999998,1948.3349999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22114,null,"See CPT",1948.3349999999998,1948.3349999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22116,null,"See CPT",239.12699999999998,239.12699999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22206,null,"See CPT",4185.5910000000003,4185.5910000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22207,null,"See CPT",4102.7939999999999,4102.7939999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22208,null,"See CPT",994.72199999999998,994.72199999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22210,null,"See CPT",3084.3330000000001,3084.3330000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22212,null,"See CPT",2595.078,2595.078,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22214,null,"See CPT",2600.8679999999999,2600.8679999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22216,null,"See CPT",617.21399999999994,617.21399999999994,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22220,null,"See CPT",2788.4639999999999,2788.4639999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22222,null,"See CPT",3010.221,3010.221,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22224,null,"See CPT",2739.828,2739.828,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22226,null,"See CPT",613.16099999999994,613.16099999999994,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22310,null,"See CPT",541.36500000000001,517.04700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[22315,null,"See CPT",1551.72,1342.1219999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[22318,null,"See CPT",2813.3610000000003,2813.3610000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[22319,null,"See CPT",3129.4949999999999,3129.4949999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[22325,null,"See CPT",2525.598,2525.598,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22326,null,"See CPT",2584.6559999999999,2584.6559999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22327,null,"See CPT",2630.9759999999997,2630.9759999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22328,null,"See CPT",475.93800000000005,475.93800000000005,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22505,null,"See CPT",224.65199999999999,224.65199999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",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",3083.1749999999997,3083.1749999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22533,null,"See CPT",2848.6800000000003,2848.6800000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22534,null,"See CPT",609.10799999999995,609.10799999999995,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22548,null,"See CPT",3357.6210000000001,3357.6210000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22551,null,"See CPT",2918.16,2918.16,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22552,null,"See CPT",671.06099999999992,671.06099999999992,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22554,null,"See CPT",2166.6179999999999,2166.6179999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22556,null,"See CPT",2857.944,2857.944,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22558,null,"See CPT",2626.3440000000001,2626.3440000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22585,null,"See CPT",552.94500000000005,552.94500000000005,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22586,null,"See CPT",3474.5789999999997,3474.5789999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22590,null,"See CPT",2718.4050000000002,2718.4050000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22595,null,"See CPT",2595.6569999999997,2595.6569999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22600,null,"See CPT",2233.7819999999997,2233.7819999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22610,null,"See CPT",2198.4629999999997,2198.4629999999997,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22612,null,"See CPT",2725.9319999999998,2725.9319999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22614,null,"See CPT",661.21799999999996,661.21799999999996,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22630,null,"See CPT",2712.6150000000002,2712.6150000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22632,null,"See CPT",541.36500000000001,541.36500000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22633,null,"See CPT",3171.183,3171.183,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22634,null,"See CPT",838.971,838.971,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22800,null,"See CPT",2338.5810000000001,2338.5810000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22802,null,"See CPT",3628.5929999999998,3628.5929999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22804,null,"See CPT",4168.8,4168.8,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22808,null,"See CPT",3127.7580000000003,3127.7580000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22810,null,"See CPT",3570.1139999999996,3570.1139999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22812,null,"See CPT",3786.0810000000001,3786.0810000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22818,null,"See CPT",3696.915,3696.915,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22819,null,"See CPT",4256.2290000000003,4256.2290000000003,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22830,null,"See CPT",1419.1290000000001,1419.1290000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22840,null,"See CPT",1285.3799999999999,1285.3799999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22841,null,"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-UR",2,29]
[22842,null,"See CPT",1290.5909999999999,1290.5909999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22843,null,"See CPT",1380.336,1380.336,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22844,null,"See CPT",1674.4680000000001,1674.4680000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22845,null,"See CPT",1232.1120000000001,1232.1120000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22846,null,"See CPT",1279.5900000000001,1279.5900000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22847,null,"See CPT",1366.44,1366.44,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22848,null,"See CPT",609.6869999999999,609.6869999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22849,null,"See CPT",2246.52,2246.52,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22850,null,"See CPT",1270.326,1270.326,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22852,null,"See CPT",1222.269,1222.269,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22853,null,"See CPT",435.98700000000002,435.98700000000002,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22854,null,"See CPT",566.26199999999994,566.26199999999994,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22855,null,"See CPT",1911.2789999999998,1911.2789999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22856,null,"See CPT",2797.7280000000001,2797.7280000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22857,null,"See CPT",3042.645,3042.645,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22858,null,"See CPT",859.81499999999994,859.81499999999994,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22859,null,"See CPT",565.68299999999999,565.68299999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22861,null,"See CPT",3950.5170000000003,3950.5170000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22862,null,"See CPT",3953.4119999999998,3953.4119999999998,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22864,null,"See CPT",3529.5839999999998,3529.5839999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22865,null,"See CPT",3859.6139999999996,3859.6139999999996,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22867,null,"See CPT",1697.6279999999999,1697.6279999999999,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22868,null,"See CPT",413.98500000000001,413.98500000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22869,null,"See CPT",772.38599999999997,772.38599999999997,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22870,null,"See CPT",209.01899999999998,209.01899999999998,"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",979.66800000000012,979.66800000000012,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22901,null,"See CPT",1153.9469999999999,1153.9469999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22902,null,"See CPT",844.18200000000002,580.73699999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22903,null,"See CPT",764.28,764.28,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",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-CM",2,29]
[23000,null,"See CPT",1031.1989999999998,634.005,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23020,null,"See CPT",1200.8459999999998,1200.8459999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23030,null,"See CPT",808.86300000000006,441.19799999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[23031,null,"See CPT",782.22899999999993,379.245,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23035,null,"See CPT",1188.6870000000001,1188.6870000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23040,null,"See CPT",1249.482,1249.482,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23044,null,"See CPT",984.3,984.3,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",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",1045.095,643.84799999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23071,null,"See CPT",730.11899999999991,730.11899999999991,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[23073,null,"See CPT",1206.636,1206.636,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23075,null,"See CPT",931.61099999999999,572.63099999999997,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23076,null,"See CPT",942.0329999999999,942.0329999999999,"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",885.87,885.87,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23101,null,"See CPT",800.75699999999995,800.75699999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23105,null,"See CPT",1120.365,1120.365,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23106,null,"See CPT",878.92199999999991,878.92199999999991,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23107,null,"See CPT",1153.9469999999999,1153.9469999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23120,null,"See CPT",1026.567,1026.567,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23125,null,"See CPT",1236.165,1236.165,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23130,null,"See CPT",1080.9930000000002,1080.9930000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23140,null,"See CPT",970.40400000000011,970.40400000000011,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23145,null,"See CPT",1212.4259999999999,1212.4259999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23146,null,"See CPT",1089.6779999999999,1089.6779999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[23150,null,"See CPT",1148.7359999999999,1148.7359999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23155,null,"See CPT",1387.8629999999998,1387.8629999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23156,null,"See CPT",1184.0549999999998,1184.0549999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23170,null,"See CPT",986.61599999999987,986.61599999999987,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23172,null,"See CPT",996.45900000000006,996.45900000000006,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23174,null,"See CPT",1331.1209999999999,1331.1209999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23180,null,"See CPT",1156.2629999999999,1156.2629999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[23182,null,"See CPT",1171.896,1171.896,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23184,null,"See CPT",1288.854,1288.854,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23190,null,"See CPT",1005.7230000000001,1005.7230000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23195,null,"See CPT",1299.855,1299.855,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",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",545.99699999999996,292.39499999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[23333,null,"See CPT",828.54899999999998,828.54899999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[23334,null,"See CPT",1844.694,1844.694,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23335,null,"See CPT",2187.462,2187.462,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23350,null,"See CPT",300.50100000000003,85.691999999999993,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[23395,null,"See CPT",2216.4119999999998,2216.4119999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[23397,null,"See CPT",1955.8620000000001,1955.8620000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[23400,null,"See CPT",1687.7849999999999,1687.7849999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23405,null,"See CPT",1081.5719999999999,1081.5719999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[23406,null,"See CPT",1322.4359999999999,1322.4359999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[23410,null,"See CPT",1423.761,1423.761,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23412,null,"See CPT",1479.924,1479.924,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23415,null,"See CPT",1216.479,1216.479,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23420,null,"See CPT",1690.1010000000001,1690.1010000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23430,null,"See CPT",1295.8019999999999,1295.8019999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23440,null,"See CPT",1313.172,1313.172,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23450,null,"See CPT",1639.1489999999999,1639.1489999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23455,null,"See CPT",1719.0509999999999,1719.0509999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23460,null,"See CPT",1887.54,1887.54,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23462,null,"See CPT",1847.0099999999998,1847.0099999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23465,null,"See CPT",1935.018,1935.018,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23466,null,"See CPT",1937.3340000000001,1937.3340000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23470,null,"See CPT",2073.9780000000001,2073.9780000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23472,null,"See CPT",2494.9110000000001,2494.9110000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23473,null,"See CPT",2780.9369999999999,2780.9369999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23474,null,"See CPT",2997.4830000000002,2997.4830000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23480,null,"See CPT",1424.9189999999999,1424.9189999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[23485,null,"See CPT",1643.7809999999999,1643.7809999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23490,null,"See CPT",1493.82,1493.82,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23491,null,"See CPT",1760.739,1760.739,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23500,null,"See CPT",396.036,404.142,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23505,null,"See CPT",635.74199999999996,589.42200000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23515,null,"See CPT",1254.114,1254.114,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23520,null,"See CPT",427.88099999999997,423.24899999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23525,null,"See CPT",702.90600000000006,640.95299999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23530,null,"See CPT",1006.3019999999999,1006.3019999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23532,null,"See CPT",1093.731,1093.731,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23540,null,"See CPT",420.93299999999999,416.30099999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23545,null,"See CPT",621.846,556.99799999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23550,null,"See CPT",999.35400000000004,999.35400000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23552,null,"See CPT",1141.788,1141.788,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23570,null,"See CPT",417.459,430.19699999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23575,null,"See CPT",725.48699999999997,669.32400000000007,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23585,null,"See CPT",1689.5219999999999,1689.5219999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23600,null,"See CPT",594.63299999999992,560.47199999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23605,null,"See CPT",835.49699999999996,754.4369999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23615,null,"See CPT",1533.771,1533.771,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23616,null,"See CPT",2133.0360000000001,2133.0360000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[23620,null,"See CPT",482.30700000000002,462.04200000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23625,null,"See CPT",678.58799999999997,621.26700000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23630,null,"See CPT",1356.597,1356.597,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23650,null,"See CPT",579.57899999999995,521.67899999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23655,null,"See CPT",719.697,719.697,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23660,null,"See CPT",1023.6719999999999,1023.6719999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23665,null,"See CPT",765.43799999999999,702.90600000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23670,null,"See CPT",1511.19,1511.19,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23675,null,"See CPT",975.03599999999994,878.92199999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23680,null,"See CPT",1607.883,1607.883,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23700,null,"See CPT",341.03099999999995,341.03099999999995,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23800,null,"See CPT",1779.8459999999998,1779.8459999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23802,null,"See CPT",2217.5699999999997,2217.5699999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23900,null,"See CPT",2389.5329999999999,2389.5329999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[23920,null,"See CPT",1943.124,1943.124,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23921,null,"See CPT",824.49599999999998,824.49599999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23929,null,"See CPT",0,0,"000",0,0,0,0,2,0,2,1,1,null,"R",null,"Y-UR",2,29]
[23930,null,"See CPT",664.11300000000006,375.19200000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23931,null,"See CPT",559.89300000000003,281.39400000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23935,null,"See CPT",895.13400000000001,895.13400000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24000,null,"See CPT",834.91800000000001,834.91800000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR",2,29]
[24006,null,"See CPT",1239.06,1239.06,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[24065,null,"See CPT",472.464,285.447,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[24066,null,"See CPT",1131.9449999999999,732.43500000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24071,null,"See CPT",706.38,706.38,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24073,null,"See CPT",1202.0040000000001,1202.0040000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24075,null,"See CPT",966.351,574.947,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24076,null,"See CPT",946.66500000000008,946.66500000000008,"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",736.48800000000006,736.48800000000006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24101,null,"See CPT",882.39599999999996,882.39599999999996,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24102,null,"See CPT",1078.6769999999999,1078.6769999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24105,null,"See CPT",632.84699999999998,632.84699999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24110,null,"See CPT",1014.9870000000001,1014.9870000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24115,null,"See CPT",1284.222,1284.222,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24116,null,"See CPT",1493.82,1493.82,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24120,null,"See CPT",932.19,932.19,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24125,null,"See CPT",1087.941,1087.941,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24126,null,"See CPT",1135.4189999999999,1135.4189999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24130,null,"See CPT",893.976,893.976,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[24134,null,"See CPT",1301.0129999999999,1301.0129999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24136,null,"See CPT",1104.732,1104.732,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24138,null,"See CPT",1200.2670000000001,1200.2670000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24140,null,"See CPT",1225.7430000000002,1225.7430000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24145,null,"See CPT",1039.3049999999998,1039.3049999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24147,null,"See CPT",1101.837,1101.837,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24149,null,"See CPT",2042.133,2042.133,"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",1478.7659999999998,1478.7659999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24160,null,"See CPT",2170.6710000000003,2170.6710000000003,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24164,null,"See CPT",1252.9559999999999,1252.9559999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24200,null,"See CPT",402.40499999999997,248.96999999999997,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[24201,null,"See CPT",997.0379999999999,638.05799999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24220,null,"See CPT",351.45300000000003,114.063,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[24300,null,"See CPT",766.596,766.596,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24301,null,"See CPT",1305.645,1305.645,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24305,null,"See CPT",1011.5129999999999,1011.5129999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24310,null,"See CPT",829.70699999999999,829.70699999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24320,null,"See CPT",1357.1759999999999,1357.1759999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24330,null,"See CPT",1250.6400000000001,1250.6400000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24331,null,"See CPT",1365.8609999999999,1365.8609999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24332,null,"See CPT",1075.7819999999999,1075.7819999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[24340,null,"See CPT",1080.9930000000002,1080.9930000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24341,null,"See CPT",1302.1709999999998,1302.1709999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24342,null,"See CPT",1347.912,1347.912,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24343,null,"See CPT",1244.8499999999999,1244.8499999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24344,null,"See CPT",1896.8039999999999,1896.8039999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24345,null,"See CPT",1236.7439999999999,1236.7439999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24346,null,"See CPT",1914.7529999999999,1914.7529999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24357,null,"See CPT",737.06700000000001,737.06700000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24358,null,"See CPT",922.92599999999993,922.92599999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24359,null,"See CPT",1153.9469999999999,1153.9469999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24360,null,"See CPT",1566.7739999999999,1566.7739999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24361,null,"See CPT",1746.2639999999999,1746.2639999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24362,null,"See CPT",1837.1669999999999,1837.1669999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24363,null,"See CPT",2496.069,2496.069,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24365,null,"See CPT",1118.049,1118.049,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24366,null,"See CPT",1186.95,1186.95,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24370,null,"See CPT",2646.03,2646.03,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24371,null,"See CPT",3043.2240000000002,3043.2240000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24400,null,"See CPT",1434.7619999999999,1434.7619999999999,"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",1838.904,1838.904,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24430,null,"See CPT",1828.4819999999997,1828.4819999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24435,null,"See CPT",1875.9599999999998,1875.9599999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24470,null,"See CPT",1173.0540000000001,1173.0540000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[24495,null,"See CPT",1347.912,1347.912,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24498,null,"See CPT",1501.9259999999999,1501.9259999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24500,null,"See CPT",644.42700000000002,590.57999999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24505,null,"See CPT",893.39699999999993,797.86199999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24515,null,"See CPT",1529.1389999999999,1529.1389999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24516,null,"See CPT",1491.5040000000001,1491.5040000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24530,null,"See CPT",681.48299999999995,621.26700000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24535,null,"See CPT",1098.3629999999998,1003.4069999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24538,null,"See CPT",1367.598,1367.598,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24545,null,"See CPT",1610.1989999999998,1610.1989999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24546,null,"See CPT",1795.479,1795.479,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24560,null,"See CPT",596.37,525.73199999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24565,null,"See CPT",957.66599999999994,869.6579999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24566,null,"See CPT",1261.6409999999998,1261.6409999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24575,null,"See CPT",1274.9579999999999,1274.9579999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24576,null,"See CPT",628.21499999999992,556.99799999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24577,null,"See CPT",984.87900000000002,892.81799999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24579,null,"See CPT",1447.5,1447.5,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24582,null,"See CPT",1426.6559999999999,1426.6559999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24586,null,"See CPT",1882.329,1882.329,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24587,null,"See CPT",1884.6449999999998,1884.6449999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24600,null,"See CPT",664.11300000000006,598.10699999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24605,null,"See CPT",842.44500000000005,842.44500000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24615,null,"See CPT",1240.797,1240.797,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24620,null,"See CPT",986.03700000000003,986.03700000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24635,null,"See CPT",1179.423,1179.423,"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",472.464,436.56599999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24655,null,"See CPT",790.91399999999999,710.43299999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24665,null,"See CPT",1152.2099999999998,1152.2099999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24666,null,"See CPT",1277.2739999999999,1277.2739999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24670,null,"See CPT",523.41599999999994,475.93800000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24675,null,"See CPT",814.07399999999996,733.59299999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24685,null,"See CPT",1144.683,1144.683,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24800,null,"See CPT",1449.2370000000001,1449.2370000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24802,null,"See CPT",1738.7370000000001,1738.7370000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24900,null,"See CPT",1282.4849999999999,1282.4849999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24920,null,"See CPT",1275.537,1275.537,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24925,null,"See CPT",995.30100000000004,995.30100000000004,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24930,null,"See CPT",1345.5959999999998,1345.5959999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24931,null,"See CPT",1613.673,1613.673,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24935,null,"See CPT",2109.297,2109.297,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24940,null,"See CPT",1945.4281704000002,1945.4281704000002,"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",607.37099999999998,607.37099999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25001,null,"See CPT",608.529,608.529,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25020,null,"See CPT",1272.6420000000001,1272.6420000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25023,null,"See CPT",2276.049,2276.049,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25024,null,"See CPT",1357.7549999999999,1357.7549999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25025,null,"See CPT",2053.134,2053.134,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25028,null,"See CPT",1189.845,1189.845,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25031,null,"See CPT",647.322,647.322,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25035,null,"See CPT",1021.9349999999999,1021.9349999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25040,null,"See CPT",977.35199999999986,977.35199999999986,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25065,null,"See CPT",469.56899999999996,277.34100000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[25066,null,"See CPT",636.9,636.9,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25071,null,"See CPT",735.90899999999999,735.90899999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25073,null,"See CPT",931.03199999999993,931.03199999999993,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25075,null,"See CPT",944.34899999999993,551.78699999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25076,null,"See CPT",899.76599999999996,899.76599999999996,"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",786.28200000000004,786.28200000000004,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25100,null,"See CPT",616.05600000000004,616.05600000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25101,null,"See CPT",711.01199999999994,711.01199999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25105,null,"See CPT",853.44600000000003,853.44600000000003,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25107,null,"See CPT",1079.8349999999998,1079.8349999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25109,null,"See CPT",933.92699999999991,933.92699999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25110,null,"See CPT",607.37099999999998,607.37099999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25111,null,"See CPT",570.89400000000001,570.89400000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25112,null,"See CPT",683.79899999999998,683.79899999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25115,null,"See CPT",1316.067,1316.067,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25116,null,"See CPT",1055.5170000000001,1055.5170000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25118,null,"See CPT",672.21899999999994,672.21899999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25119,null,"See CPT",872.553,872.553,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25120,null,"See CPT",877.76400000000001,877.76400000000001,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25125,null,"See CPT",1041.0419999999999,1041.0419999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25126,null,"See CPT",1048.569,1048.569,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25130,null,"See CPT",791.49299999999994,791.49299999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25135,null,"See CPT",981.98400000000004,981.98400000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25136,null,"See CPT",872.553,872.553,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25145,null,"See CPT",913.08299999999997,913.08299999999997,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25150,null,"See CPT",992.40600000000006,992.40600000000006,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25151,null,"See CPT",1021.356,1021.356,"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",862.71,862.71,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25215,null,"See CPT",1080.9930000000002,1080.9930000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25230,null,"See CPT",757.91099999999994,757.91099999999994,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25240,null,"See CPT",753.85799999999995,753.85799999999995,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25246,null,"See CPT",357.822,124.48499999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[25248,null,"See CPT",735.32999999999993,735.32999999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25250,null,"See CPT",935.66399999999999,935.66399999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25251,null,"See CPT",1253.5349999999999,1253.5349999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25259,null,"See CPT",757.33199999999999,757.33199999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25260,null,"See CPT",1107.048,1107.048,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25263,null,"See CPT",1108.7849999999999,1108.7849999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25265,null,"See CPT",1312.5930000000001,1312.5930000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25270,null,"See CPT",864.447,864.447,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25272,null,"See CPT",979.66800000000012,979.66800000000012,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25274,null,"See CPT",1159.7370000000001,1159.7370000000001,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25275,null,"See CPT",1170.7379999999998,1170.7379999999998,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25280,null,"See CPT",989.51099999999997,989.51099999999997,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25290,null,"See CPT",763.70099999999991,763.70099999999991,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25295,null,"See CPT",921.76800000000003,921.76800000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25300,null,"See CPT",1205.4780000000001,1205.4780000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25301,null,"See CPT",1122.681,1122.681,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25310,null,"See CPT",1082.73,1082.73,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25312,null,"See CPT",1243.1129999999998,1243.1129999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25315,null,"See CPT",1339.2269999999999,1339.2269999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25316,null,"See CPT",1590.5129999999999,1590.5129999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25320,null,"See CPT",1713.8400000000001,1713.8400000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[25332,null,"See CPT",1464.8700000000001,1464.8700000000001,"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",1543.614,1543.614,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25350,null,"See CPT",1175.9489999999998,1175.9489999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25355,null,"See CPT",1332.8579999999999,1332.8579999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25360,null,"See CPT",1140.0510000000002,1140.0510000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25365,null,"See CPT",1592.25,1592.25,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25370,null,"See CPT",1757.2650000000001,1757.2650000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25375,null,"See CPT",1655.3609999999999,1655.3609999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25390,null,"See CPT",1336.9110000000001,1336.9110000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25391,null,"See CPT",1728.3150000000001,1728.3150000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25392,null,"See CPT",1757.8439999999998,1757.8439999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25393,null,"See CPT",1954.125,1954.125,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25394,null,"See CPT",1364.1239999999998,1364.1239999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25400,null,"See CPT",1394.232,1394.232,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25405,null,"See CPT",1796.058,1796.058,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25415,null,"See CPT",1680.837,1680.837,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25420,null,"See CPT",2017.8150000000001,2017.8150000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25425,null,"See CPT",1672.1519999999998,1672.1519999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25426,null,"See CPT",1943.703,1943.703,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25430,null,"See CPT",1274.9579999999999,1274.9579999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25431,null,"See CPT",1370.4930000000002,1370.4930000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25440,null,"See CPT",1334.595,1334.595,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25441,null,"See CPT",1628.7269999999999,1628.7269999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25442,null,"See CPT",1404.654,1404.654,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25443,null,"See CPT",1366.44,1366.44,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25444,null,"See CPT",1437.6569999999999,1437.6569999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25445,null,"See CPT",1254.114,1254.114,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25446,null,"See CPT",2025.3419999999999,2025.3419999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25447,null,"See CPT",1444.605,1444.605,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25449,null,"See CPT",1787.952,1787.952,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25450,null,"See CPT",1079.8349999999998,1079.8349999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25455,null,"See CPT",1273.2209999999998,1273.2209999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25490,null,"See CPT",1252.377,1252.377,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25491,null,"See CPT",1287.6959999999999,1287.6959999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25492,null,"See CPT",1573.722,1573.722,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25500,null,"See CPT",508.94099999999992,457.41,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25505,null,"See CPT",898.60799999999995,811.75799999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25515,null,"See CPT",1169.001,1169.001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25520,null,"See CPT",1020.198,957.66599999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25525,null,"See CPT",1373.9670000000001,1373.9670000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25526,null,"See CPT",1661.1510000000001,1661.1510000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25530,null,"See CPT",473.04300000000001,431.35500000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25535,null,"See CPT",880.65899999999999,807.70499999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25545,null,"See CPT",1091.415,1091.415,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25560,null,"See CPT",518.78399999999999,459.726,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25565,null,"See CPT",920.03100000000006,819.86400000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25574,null,"See CPT",1178.8440000000001,1178.8440000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25575,null,"See CPT",1571.4059999999999,1571.4059999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25600,null,"See CPT",605.05499999999995,575.52599999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25605,null,"See CPT",958.245,901.50300000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25606,null,"See CPT",1166.106,1166.106,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25607,null,"See CPT",1288.2749999999999,1288.2749999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25608,null,"See CPT",1437.6569999999999,1437.6569999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25609,null,"See CPT",1823.85,1823.85,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25622,null,"See CPT",550.04999999999995,504.30900000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25624,null,"See CPT",871.39499999999998,785.12400000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25628,null,"See CPT",1255.2719999999999,1255.2719999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25630,null,"See CPT",547.15499999999997,504.88800000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25635,null,"See CPT",827.39099999999996,746.91,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25645,null,"See CPT",999.93299999999999,999.93299999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25650,null,"See CPT",588.26400000000001,542.52299999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25651,null,"See CPT",860.39399999999989,860.39399999999989,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25652,null,"See CPT",1088.52,1088.52,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25660,null,"See CPT",789.17700000000002,789.17700000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25670,null,"See CPT",1063.623,1063.623,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25671,null,"See CPT",933.92699999999991,933.92699999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25675,null,"See CPT",796.70399999999995,715.64400000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25676,null,"See CPT",1102.9950000000001,1102.9950000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25680,null,"See CPT",928.71599999999989,928.71599999999989,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25685,null,"See CPT",1281.327,1281.327,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25690,null,"See CPT",862.71,862.71,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25695,null,"See CPT",1108.2059999999999,1108.2059999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25800,null,"See CPT",1274.9579999999999,1274.9579999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25805,null,"See CPT",1474.134,1474.134,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25810,null,"See CPT",1503.663,1503.663,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25820,null,"See CPT",1134.261,1134.261,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25825,null,"See CPT",1383.231,1383.231,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25830,null,"See CPT",1790.847,1790.847,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25900,null,"See CPT",1247.7450000000001,1247.7450000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25905,null,"See CPT",1222.269,1222.269,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25907,null,"See CPT",1074.0450000000001,1074.0450000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25909,null,"See CPT",1195.635,1195.635,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25915,null,"See CPT",2014.9199999999998,2014.9199999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25920,null,"See CPT",1274.3790000000001,1274.3790000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25922,null,"See CPT",1131.366,1131.366,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25924,null,"See CPT",1245.4290000000001,1245.4290000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25927,null,"See CPT",1530.297,1530.297,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25929,null,"See CPT",1046.8319999999999,1046.8319999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25931,null,"See CPT",1419.1290000000001,1419.1290000000001,"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",618.95099999999991,247.81200000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26011,null,"See CPT",871.39499999999998,324.81900000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26020,null,"See CPT",974.45699999999988,974.45699999999988,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26025,null,"See CPT",741.69899999999996,741.69899999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26030,null,"See CPT",856.34099999999989,856.34099999999989,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26034,null,"See CPT",964.03499999999985,964.03499999999985,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26035,null,"See CPT",1499.61,1499.61,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26037,null,"See CPT",981.40499999999997,981.40499999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26040,null,"See CPT",556.99799999999993,556.99799999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26045,null,"See CPT",828.54899999999998,828.54899999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26055,null,"See CPT",1067.097,513.57299999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26060,null,"See CPT",453.93599999999998,453.93599999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26070,null,"See CPT",572.05200000000002,572.05200000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26075,null,"See CPT",594.05399999999997,594.05399999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26080,null,"See CPT",700.58999999999992,700.58999999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26100,null,"See CPT",598.68599999999992,598.68599999999992,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26105,null,"See CPT",602.73900000000003,602.73900000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26110,null,"See CPT",572.63099999999997,572.63099999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26111,null,"See CPT",724.9079999999999,724.9079999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26113,null,"See CPT",953.61299999999994,953.61299999999994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26115,null,"See CPT",995.87999999999988,580.73699999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26116,null,"See CPT",916.55700000000002,916.55700000000002,"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",1046.8319999999999,1046.8319999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26123,null,"See CPT",1456.1849999999999,1456.1849999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26125,null,"See CPT",459.726,459.726,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26130,null,"See CPT",823.33799999999997,823.33799999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26135,null,"See CPT",968.66700000000003,968.66700000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26140,null,"See CPT",888.76499999999999,888.76499999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26145,null,"See CPT",902.08199999999999,902.08199999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26160,null,"See CPT",1107.048,555.83999999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26170,null,"See CPT",717.38099999999997,717.38099999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26180,null,"See CPT",789.17700000000002,789.17700000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26185,null,"See CPT",976.19399999999996,976.19399999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26200,null,"See CPT",789.75599999999997,789.75599999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26205,null,"See CPT",1058.991,1058.991,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26210,null,"See CPT",783.96599999999989,783.96599999999989,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26215,null,"See CPT",992.9849999999999,992.9849999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26230,null,"See CPT",874.29,874.29,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26235,null,"See CPT",860.97299999999996,860.97299999999996,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26236,null,"See CPT",774.12299999999993,774.12299999999993,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26250,null,"See CPT",1844.694,1844.694,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26260,null,"See CPT",1383.81,1383.81,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26262,null,"See CPT",1099.521,1099.521,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26320,null,"See CPT",614.89799999999991,614.89799999999991,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26340,null,"See CPT",622.42499999999995,622.42499999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26341,null,"See CPT",201.49199999999999,135.48599999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[26350,null,"See CPT",1343.28,1343.28,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26352,null,"See CPT",1497.873,1497.873,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26356,null,"See CPT",1397.7059999999999,1397.7059999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26357,null,"See CPT",1566.1949999999999,1566.1949999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26358,null,"See CPT",1725.42,1725.42,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26370,null,"See CPT",1413.3389999999999,1413.3389999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26372,null,"See CPT",1644.9390000000001,1644.9390000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26373,null,"See CPT",1585.8810000000001,1585.8810000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26390,null,"See CPT",1555.7729999999999,1555.7729999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26392,null,"See CPT",1793.1629999999998,1793.1629999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26410,null,"See CPT",1085.0459999999998,1085.0459999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26412,null,"See CPT",1287.117,1287.117,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26415,null,"See CPT",1522.1909999999998,1522.1909999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26416,null,"See CPT",1642.0439999999999,1642.0439999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26418,null,"See CPT",1123.26,1123.26,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26420,null,"See CPT",1331.1209999999999,1331.1209999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26426,null,"See CPT",880.65899999999999,880.65899999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26428,null,"See CPT",1428.393,1428.393,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26432,null,"See CPT",975.03599999999994,975.03599999999994,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26433,null,"See CPT",1026.567,1026.567,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26434,null,"See CPT",1242.5340000000001,1242.5340000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26437,null,"See CPT",1189.2659999999998,1189.2659999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26440,null,"See CPT",1181.1599999999999,1181.1599999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26442,null,"See CPT",1764.213,1764.213,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26445,null,"See CPT",1107.048,1107.048,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26449,null,"See CPT",1219.3739999999998,1219.3739999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26450,null,"See CPT",814.65300000000002,814.65300000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26455,null,"See CPT",808.86300000000006,808.86300000000006,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26460,null,"See CPT",794.96699999999998,794.96699999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26471,null,"See CPT",1180.5809999999999,1180.5809999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26474,null,"See CPT",1166.106,1166.106,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26476,null,"See CPT",1152.2099999999998,1152.2099999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26477,null,"See CPT",1118.6279999999999,1118.6279999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26478,null,"See CPT",1184.0549999999998,1184.0549999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26479,null,"See CPT",1207.7939999999999,1207.7939999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26480,null,"See CPT",1413.3389999999999,1413.3389999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26483,null,"See CPT",1563.8790000000001,1563.8790000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26485,null,"See CPT",1502.5049999999999,1502.5049999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26489,null,"See CPT",1729.473,1729.473,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26490,null,"See CPT",1490.3459999999998,1490.3459999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26492,null,"See CPT",1643.7809999999999,1643.7809999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26494,null,"See CPT",1496.136,1496.136,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26496,null,"See CPT",1606.7249999999999,1606.7249999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26497,null,"See CPT",1604.9879999999998,1604.9879999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26498,null,"See CPT",2078.6099999999997,2078.6099999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26499,null,"See CPT",1547.088,1547.088,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26500,null,"See CPT",1182.318,1182.318,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26502,null,"See CPT",1347.3329999999999,1347.3329999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26508,null,"See CPT",1205.4780000000001,1205.4780000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26510,null,"See CPT",1147.578,1147.578,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26516,null,"See CPT",1323.0150000000001,1323.0150000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26517,null,"See CPT",1538.403,1538.403,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26518,null,"See CPT",1556.931,1556.931,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26520,null,"See CPT",1236.7439999999999,1236.7439999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26525,null,"See CPT",1239.6389999999999,1239.6389999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26530,null,"See CPT",945.50699999999983,945.50699999999983,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26531,null,"See CPT",1100.6790000000001,1100.6790000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26535,null,"See CPT",767.17499999999995,767.17499999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26536,null,"See CPT",1347.3329999999999,1347.3329999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26540,null,"See CPT",1248.903,1248.903,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[26541,null,"See CPT",1480.5029999999999,1480.5029999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26542,null,"See CPT",1287.6959999999999,1287.6959999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26545,null,"See CPT",1305.645,1305.645,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26546,null,"See CPT",1826.7449999999999,1826.7449999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26548,null,"See CPT",1417.9709999999998,1417.9709999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26550,null,"See CPT",2912.9490000000001,2912.9490000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26551,null,"See CPT",5726.31,5726.31,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26553,null,"See CPT",5688.0959999999995,5688.0959999999995,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26554,null,"See CPT",6612.7589999999991,6612.7589999999991,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26555,null,"See CPT",2456.6970000000001,2456.6970000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26556,null,"See CPT",5914.4850000000006,5914.4850000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26560,null,"See CPT",1138.893,1138.893,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26561,null,"See CPT",1738.1579999999999,1738.1579999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26562,null,"See CPT",2416.7460000000001,2416.7460000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26565,null,"See CPT",1307.3819999999998,1307.3819999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26567,null,"See CPT",1285.9590000000001,1285.9590000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26568,null,"See CPT",1670.9939999999999,1670.9939999999999,"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",875.44799999999998,875.44799999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26593,null,"See CPT",1155.105,1155.105,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26596,null,"See CPT",1431.288,1431.288,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26600,null,"See CPT",537.89099999999996,508.94099999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26605,null,"See CPT",588.84299999999996,527.46899999999994,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26607,null,"See CPT",891.08100000000002,891.08100000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26608,null,"See CPT",850.55099999999993,850.55099999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26615,null,"See CPT",1009.197,1009.197,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26641,null,"See CPT",745.17299999999989,674.53499999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26645,null,"See CPT",769.49099999999999,696.53699999999992,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26650,null,"See CPT",851.70900000000006,851.70900000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26665,null,"See CPT",1094.8889999999999,1094.8889999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[26670,null,"See CPT",621.846,552.36599999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26675,null,"See CPT",819.86400000000003,744.01499999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26676,null,"See CPT",899.1869999999999,899.1869999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26685,null,"See CPT",1009.7760000000001,1009.7760000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26686,null,"See CPT",1091.415,1091.415,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26700,null,"See CPT",597.52800000000002,548.89200000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26705,null,"See CPT",755.01599999999996,680.904,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26706,null,"See CPT",783.96599999999989,783.96599999999989,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26715,null,"See CPT",1003.986,1003.986,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26720,null,"See CPT",356.66399999999999,333.50399999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26725,null,"See CPT",609.10799999999995,538.47,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26727,null,"See CPT",836.65499999999997,836.65499999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26735,null,"See CPT",1042.779,1042.779,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26740,null,"See CPT",414.56400000000002,390.82499999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26742,null,"See CPT",667.00799999999992,595.21199999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26746,null,"See CPT",1294.0650000000001,1294.0650000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26750,null,"See CPT",333.50399999999996,335.24099999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26755,null,"See CPT",572.63099999999997,487.51799999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26756,null,"See CPT",749.226,749.226,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26765,null,"See CPT",883.55399999999997,883.55399999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26770,null,"See CPT",508.36199999999997,461.46299999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26775,null,"See CPT",700.01099999999997,624.74099999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26776,null,"See CPT",793.80900000000008,793.80900000000008,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26785,null,"See CPT",958.82399999999996,958.82399999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26820,null,"See CPT",1475.8709999999999,1475.8709999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26841,null,"See CPT",1373.3879999999999,1373.3879999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[26842,null,"See CPT",1479.924,1479.924,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26843,null,"See CPT",1394.232,1394.232,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26844,null,"See CPT",1527.981,1527.981,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26850,null,"See CPT",1306.8029999999999,1306.8029999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26852,null,"See CPT",1477.6079999999999,1477.6079999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26860,null,"See CPT",1094.31,1094.31,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26861,null,"See CPT",173.7,173.7,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26862,null,"See CPT",1362.3869999999999,1362.3869999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26863,null,"See CPT",386.19299999999998,386.19299999999998,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[26910,null,"See CPT",1351.386,1351.386,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26951,null,"See CPT",1244.271,1244.271,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26952,null,"See CPT",1217.058,1217.058,"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",1185.7919999999999,1185.7919999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26991,null,"See CPT",1278.4319999999998,915.399,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26992,null,"See CPT",1750.896,1750.896,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[27000,null,"See CPT",716.80200000000002,716.80200000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27001,null,"See CPT",944.928,944.928,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27003,null,"See CPT",1046.2529999999999,1046.2529999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27005,null,"See CPT",1250.6400000000001,1250.6400000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27006,null,"See CPT",1256.4299999999998,1256.4299999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27025,null,"See CPT",1598.04,1598.04,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27027,null,"See CPT",1527.4019999999998,1527.4019999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27030,null,"See CPT",1622.9370000000001,1622.9370000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27033,null,"See CPT",1685.4689999999998,1685.4689999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27035,null,"See CPT",1998.7080000000001,1998.7080000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27036,null,"See CPT",1761.318,1761.318,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27040,null,"See CPT",630.53100000000006,346.24200000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27041,null,"See CPT",1219.3739999999998,1219.3739999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27043,null,"See CPT",812.33699999999999,812.33699999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27045,null,"See CPT",1275.537,1275.537,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27047,null,"See CPT",881.23800000000006,627.05700000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27048,null,"See CPT",1061.3069999999998,1061.3069999999998,"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",710.43299999999999,710.43299999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27052,null,"See CPT",1010.934,1010.934,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27054,null,"See CPT",1199.1089999999999,1199.1089999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27057,null,"See CPT",1749.7379999999998,1749.7379999999998,"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",816.39,816.39,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27062,null,"See CPT",796.70399999999995,796.70399999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27065,null,"See CPT",920.61,920.61,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27066,null,"See CPT",1420.287,1420.287,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27067,null,"See CPT",1794.8999999999999,1794.8999999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27070,null,"See CPT",1552.299,1552.299,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27071,null,"See CPT",1692.4169999999999,1692.4169999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27075,null,"See CPT",3581.1149999999998,3581.1149999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27076,null,"See CPT",4325.7089999999998,4325.7089999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27077,null,"See CPT",4822.491,4822.491,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27078,null,"See CPT",3531.9,3531.9,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27080,null,"See CPT",889.34399999999994,889.34399999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27086,null,"See CPT",571.47299999999996,294.13200000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27087,null,"See CPT",1067.097,1067.097,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27090,null,"See CPT",1439.394,1439.394,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27091,null,"See CPT",2742.1439999999998,2742.1439999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27093,null,"See CPT",434.25,116.37899999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27095,null,"See CPT",588.84299999999996,141.85500000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27096,null,"See CPT",300.50100000000003,143.59199999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27097,null,"See CPT",1190.424,1190.424,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27098,null,"See CPT",1212.4259999999999,1212.4259999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27100,null,"See CPT",1443.4469999999999,1443.4469999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27105,null,"See CPT",1511.19,1511.19,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27110,null,"See CPT",1683.153,1683.153,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27111,null,"See CPT",1567.9319999999998,1567.9319999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27120,null,"See CPT",2242.4669999999996,2242.4669999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27122,null,"See CPT",1907.8050000000001,1907.8050000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27125,null,"See CPT",1955.2830000000001,1955.2830000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27130,null,"See CPT",2214.6749999999997,2214.6749999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27132,null,"See CPT",2875.3139999999999,2875.3139999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27134,null,"See CPT",3272.5080000000003,3272.5080000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27137,null,"See CPT",2523.2819999999997,2523.2819999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27138,null,"See CPT",2621.712,2621.712,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27140,null,"See CPT",1548.825,1548.825,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27146,null,"See CPT",2209.4639999999999,2209.4639999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27147,null,"See CPT",2521.5449999999996,2521.5449999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27151,null,"See CPT",2725.3530000000001,2725.3530000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27156,null,"See CPT",2933.7930000000001,2933.7930000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27158,null,"See CPT",2413.8509999999997,2413.8509999999997,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,null,2,29]
[27161,null,"See CPT",2102.9279999999999,2102.9279999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27165,null,"See CPT",2380.2689999999998,2380.2689999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27170,null,"See CPT",2020.7099999999998,2020.7099999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27175,null,"See CPT",1155.684,1155.684,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27176,null,"See CPT",1599.1980000000001,1599.1980000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27177,null,"See CPT",1930.3860000000002,1930.3860000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27178,null,"See CPT",1599.1980000000001,1599.1980000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27179,null,"See CPT",1697.049,1697.049,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27181,null,"See CPT",1937.3340000000001,1937.3340000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27185,null,"See CPT",1250.6400000000001,1250.6400000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27187,null,"See CPT",1725.9989999999998,1725.9989999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27197,null,"See CPT",231.02100000000002,231.02100000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[27198,null,"See CPT",548.31299999999999,548.31299999999999,"000",0,0,0,0,2,0,0,2,0,null,"R",null,null,2,29]
[27200,null,"See CPT",330.03000000000003,332.346,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[27202,null,"See CPT",919.452,919.452,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[27215,null,"See CPT",1049.1480000000001,1049.1480000000001,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27216,null,"See CPT",1551.72,1551.72,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27217,null,"See CPT",1458.501,1458.501,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27218,null,"See CPT",1999.287,1999.287,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27220,null,"See CPT",730.11899999999991,719.697,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27222,null,"See CPT",1695.3120000000001,1695.3120000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27226,null,"See CPT",1826.7449999999999,1826.7449999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27227,null,"See CPT",2843.4690000000001,2843.4690000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27228,null,"See CPT",3223.8719999999998,3223.8719999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27230,null,"See CPT",852.86699999999996,836.65499999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27232,null,"See CPT",1279.5900000000001,1279.5900000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27235,null,"See CPT",1571.9849999999999,1571.9849999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27236,null,"See CPT",2061.2400000000002,2061.2400000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27238,null,"See CPT",818.12700000000007,818.12700000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27240,null,"See CPT",1663.4669999999999,1663.4669999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27244,null,"See CPT",2120.2979999999998,2120.2979999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27245,null,"See CPT",2117.982,2117.982,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27246,null,"See CPT",685.53599999999994,677.43,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27248,null,"See CPT",1292.328,1292.328,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27250,null,"See CPT",305.71199999999999,305.71199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27252,null,"See CPT",1312.0139999999999,1312.0139999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27253,null,"See CPT",1629.885,1629.885,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27254,null,"See CPT",2196.7259999999997,2196.7259999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27256,null,"See CPT",533.25900000000001,408.19499999999999,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27257,null,"See CPT",623.58299999999997,623.58299999999997,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27258,null,"See CPT",1922.8589999999999,1922.8589999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27259,null,"See CPT",2661.0839999999998,2661.0839999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27265,null,"See CPT",719.697,719.697,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27266,null,"See CPT",1020.198,1020.198,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27267,null,"See CPT",768.91199999999992,768.91199999999992,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27268,null,"See CPT",948.98099999999999,948.98099999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27269,null,"See CPT",2139.4050000000002,2139.4050000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27275,null,"See CPT",321.92399999999998,321.92399999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[27279,null,"See CPT",1492.0829999999999,1492.0829999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27280,null,"See CPT",2334.5279999999998,2334.5279999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27282,null,"See CPT",1492.0829999999999,1492.0829999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27284,null,"See CPT",2760.0929999999998,2760.0929999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27286,null,"See CPT",2829.5729999999999,2829.5729999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27290,null,"See CPT",2800.0439999999999,2800.0439999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27295,null,"See CPT",2149.8270000000002,2149.8270000000002,"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,null,2,29]
[27301,null,"See CPT",1211.268,881.23800000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27303,null,"See CPT",1122.681,1122.681,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27305,null,"See CPT",843.60299999999995,843.60299999999995,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27306,null,"See CPT",591.73800000000006,591.73800000000006,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27307,null,"See CPT",841.28699999999992,841.28699999999992,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27310,null,"See CPT",1274.3790000000001,1274.3790000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27323,null,"See CPT",497.93999999999994,303.97499999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27324,null,"See CPT",712.17000000000007,712.17000000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27325,null,"See CPT",986.61599999999987,986.61599999999987,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27326,null,"See CPT",914.82,914.82,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27327,null,"See CPT",905.55600000000004,547.15499999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27328,null,"See CPT",1079.8349999999998,1079.8349999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27329,null,"See CPT",1790.847,1790.847,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27330,null,"See CPT",735.90899999999999,735.90899999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27331,null,"See CPT",834.33899999999994,834.33899999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27332,null,"See CPT",1127.3129999999999,1127.3129999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27333,null,"See CPT",1029.462,1029.462,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27334,null,"See CPT",1195.635,1195.635,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27335,null,"See CPT",1332.8579999999999,1332.8579999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27337,null,"See CPT",727.803,727.803,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27339,null,"See CPT",1301.5920000000001,1301.5920000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27340,null,"See CPT",657.74399999999991,657.74399999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27345,null,"See CPT",849.39300000000003,849.39300000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27347,null,"See CPT",922.92599999999993,922.92599999999993,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27350,null,"See CPT",1140.0510000000002,1140.0510000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27355,null,"See CPT",1058.412,1058.412,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27356,null,"See CPT",1288.854,1288.854,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27357,null,"See CPT",1421.4449999999999,1421.4449999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27358,null,"See CPT",468.411,468.411,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27360,null,"See CPT",1569.0900000000001,1569.0900000000001,"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",3529.5839999999998,3529.5839999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27369,null,"See CPT",317.87099999999998,68.321999999999989,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27372,null,"See CPT",1079.8349999999998,702.327,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27380,null,"See CPT",1091.415,1091.415,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27381,null,"See CPT",1431.867,1431.867,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27385,null,"See CPT",1063.623,1063.623,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27386,null,"See CPT",1497.873,1497.873,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27390,null,"See CPT",789.17700000000002,789.17700000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27391,null,"See CPT",959.98199999999986,959.98199999999986,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[27392,null,"See CPT",1241.9549999999999,1241.9549999999999,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27393,null,"See CPT",879.50099999999998,879.50099999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27394,null,"See CPT",1143.5249999999999,1143.5249999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27395,null,"See CPT",1531.4549999999999,1531.4549999999999,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27396,null,"See CPT",1079.2560000000001,1079.2560000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27397,null,"See CPT",1588.1969999999999,1588.1969999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27400,null,"See CPT",1213.0049999999999,1213.0049999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27403,null,"See CPT",1124.4180000000001,1124.4180000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27405,null,"See CPT",1180.002,1180.002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27407,null,"See CPT",1386.7049999999999,1386.7049999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27409,null,"See CPT",1677.3629999999998,1677.3629999999998,"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,null,2,29]
[27415,null,"See CPT",2371.0050000000001,2371.0050000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27416,null,"See CPT",1696.47,1696.47,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[27418,null,"See CPT",1444.0260000000001,1444.0260000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27420,null,"See CPT",1294.644,1294.644,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27422,null,"See CPT",1295.223,1295.223,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27424,null,"See CPT",1302.75,1302.75,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27425,null,"See CPT",794.96699999999998,794.96699999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27427,null,"See CPT",1240.2180000000001,1240.2180000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27428,null,"See CPT",1936.1759999999999,1936.1759999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27429,null,"See CPT",2178.777,2178.777,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27430,null,"See CPT",1292.9069999999999,1292.9069999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27435,null,"See CPT",1411.6019999999999,1411.6019999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27437,null,"See CPT",1153.3680000000002,1153.3680000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27438,null,"See CPT",1459.08,1459.08,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27440,null,"See CPT",1386.126,1386.126,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27441,null,"See CPT",1431.288,1431.288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27442,null,"See CPT",1511.19,1511.19,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27443,null,"See CPT",1418.55,1418.55,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27445,null,"See CPT",2164.3020000000001,2164.3020000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27446,null,"See CPT",1991.181,1991.181,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27447,null,"See CPT",2212.3589999999999,2212.3589999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27448,null,"See CPT",1401.759,1401.759,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27450,null,"See CPT",1761.8969999999999,1761.8969999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27454,null,"See CPT",2233.7819999999997,2233.7819999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27455,null,"See CPT",1665.7829999999999,1665.7829999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27457,null,"See CPT",1663.4669999999999,1663.4669999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27465,null,"See CPT",2153.88,2153.88,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27466,null,"See CPT",2047.9229999999998,2047.9229999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27468,null,"See CPT",2315.4210000000003,2315.4210000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27470,null,"See CPT",2037.5009999999997,2037.5009999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27472,null,"See CPT",2181.672,2181.672,"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,null,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,null,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,null,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,null,2,29]
[27486,null,"See CPT",2421.3780000000002,2421.3780000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27487,null,"See CPT",3015.4319999999998,3015.4319999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27488,null,"See CPT",2073.3989999999999,2073.3989999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27495,null,"See CPT",1954.125,1954.125,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27496,null,"See CPT",961.1400000000001,961.1400000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27497,null,"See CPT",1013.8290000000001,1013.8290000000001,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R",null,null,2,29]
[27498,null,"See CPT",1146.42,1146.42,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27499,null,"See CPT",1222.269,1222.269,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27500,null,"See CPT",918.87299999999993,840.70799999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27501,null,"See CPT",889.92299999999989,871.39499999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27502,null,"See CPT",1313.751,1313.751,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27503,null,"See CPT",1392.4950000000001,1392.4950000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27506,null,"See CPT",2310.21,2310.21,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27507,null,"See CPT",1672.731,1672.731,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27508,null,"See CPT",926.4,874.29,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27509,null,"See CPT",1181.739,1181.739,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27510,null,"See CPT",1185.213,1185.213,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27511,null,"See CPT",1721.367,1721.367,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27513,null,"See CPT",2131.299,2131.299,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27514,null,"See CPT",1669.2569999999998,1669.2569999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27516,null,"See CPT",914.24099999999987,850.55099999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27517,null,"See CPT",1200.8459999999998,1200.8459999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27519,null,"See CPT",1541.877,1541.877,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27520,null,"See CPT",581.31599999999992,533.83800000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27524,null,"See CPT",1309.6980000000001,1309.6980000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27530,null,"See CPT",549.471,513.57299999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27532,null,"See CPT",1086.7829999999999,1009.197,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27535,null,"See CPT",1551.72,1551.72,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27536,null,"See CPT",2048.502,2048.502,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27538,null,"See CPT",856.34099999999989,792.65099999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27540,null,"See CPT",1413.9180000000001,1413.9180000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27550,null,"See CPT",931.61099999999999,856.34099999999989,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27552,null,"See CPT",1108.7849999999999,1108.7849999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27556,null,"See CPT",1516.98,1516.98,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27557,null,"See CPT",1804.7430000000002,1804.7430000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27558,null,"See CPT",2051.3969999999999,2051.3969999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27560,null,"See CPT",669.90300000000002,610.84500000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27562,null,"See CPT",858.07799999999997,858.07799999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27566,null,"See CPT",1547.6669999999999,1547.6669999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27570,null,"See CPT",265.76099999999997,265.76099999999997,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27580,null,"See CPT",2540.652,2540.652,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27590,null,"See CPT",1348.491,1348.491,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27591,null,"See CPT",1670.9939999999999,1670.9939999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27592,null,"See CPT",1150.473,1150.473,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27594,null,"See CPT",879.50099999999998,879.50099999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27596,null,"See CPT",1228.6379999999999,1228.6379999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27598,null,"See CPT",1213.0049999999999,1213.0049999999999,"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",698.85299999999995,698.85299999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27601,null,"See CPT",774.12299999999993,774.12299999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27602,null,"See CPT",827.97,827.97,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27603,null,"See CPT",963.45600000000002,684.37800000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27604,null,"See CPT",841.86599999999999,574.36799999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27605,null,"See CPT",617.79300000000001,320.18700000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27606,null,"See CPT",474.20099999999996,474.20099999999996,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,null,2,29]
[27607,null,"See CPT",1042.779,1042.779,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27610,null,"See CPT",1129.6290000000001,1129.6290000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27612,null,"See CPT",969.24599999999987,969.24599999999987,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27613,null,"See CPT",460.88400000000001,279.65699999999998,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27614,null,"See CPT",1046.8319999999999,712.74900000000002,"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",876.60599999999999,531.52199999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27619,null,"See CPT",798.44099999999992,798.44099999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27620,null,"See CPT",786.28200000000004,786.28200000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27625,null,"See CPT",993.56399999999996,993.56399999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27626,null,"See CPT",1043.9370000000001,1043.9370000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27630,null,"See CPT",990.66899999999998,628.21499999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27632,null,"See CPT",715.06499999999994,715.06499999999994,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27634,null,"See CPT",1172.4749999999999,1172.4749999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27635,null,"See CPT",1013.8290000000001,1013.8290000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27637,null,"See CPT",1290.0119999999999,1290.0119999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27638,null,"See CPT",1314.9090000000001,1314.9090000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27640,null,"See CPT",1440.5519999999999,1440.5519999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27641,null,"See CPT",1137.7349999999999,1137.7349999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27645,null,"See CPT",3042.0659999999998,3042.0659999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27646,null,"See CPT",2646.03,2646.03,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27647,null,"See CPT",1710.9449999999999,1710.9449999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27648,null,"See CPT",402.40499999999997,88.587000000000003,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[27650,null,"See CPT",1148.1569999999999,1148.1569999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27652,null,"See CPT",1148.1569999999999,1148.1569999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27654,null,"See CPT",1236.7439999999999,1236.7439999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27656,null,"See CPT",1005.1439999999999,616.63499999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27658,null,"See CPT",643.84799999999996,643.84799999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27659,null,"See CPT",815.23199999999997,815.23199999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27664,null,"See CPT",632.84699999999998,632.84699999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[27665,null,"See CPT",736.48800000000006,736.48800000000006,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27675,null,"See CPT",853.44600000000003,853.44600000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27676,null,"See CPT",1041.0419999999999,1041.0419999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27680,null,"See CPT",731.27700000000004,731.27700000000004,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[27681,null,"See CPT",899.76599999999996,899.76599999999996,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27685,null,"See CPT",1183.4760000000001,807.12599999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27686,null,"See CPT",933.34800000000007,933.34800000000007,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27687,null,"See CPT",789.75599999999997,789.75599999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27690,null,"See CPT",1118.049,1118.049,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27691,null,"See CPT",1294.0650000000001,1294.0650000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27692,null,"See CPT",173.7,173.7,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[27695,null,"See CPT",827.39099999999996,827.39099999999996,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27696,null,"See CPT",954.77099999999984,954.77099999999984,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27698,null,"See CPT",1106.4690000000001,1106.4690000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27700,null,"See CPT",1052.6220000000001,1052.6220000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27702,null,"See CPT",1666.9409999999998,1666.9409999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27703,null,"See CPT",1926.3330000000001,1926.3330000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27704,null,"See CPT",995.30100000000004,995.30100000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27705,null,"See CPT",1313.751,1313.751,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27707,null,"See CPT",700.58999999999992,700.58999999999992,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27709,null,"See CPT",1992.3389999999997,1992.3389999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27712,null,"See CPT",1907.8050000000001,1907.8050000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27715,null,"See CPT",1856.8530000000001,1856.8530000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27720,null,"See CPT",1518.1379999999999,1518.1379999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27722,null,"See CPT",1553.4569999999999,1553.4569999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27724,null,"See CPT",2164.8809999999999,2164.8809999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27725,null,"See CPT",2102.3490000000002,2102.3490000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27726,null,"See CPT",1658.2560000000001,1658.2560000000001,"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",1028.3040000000001,1028.3040000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[27732,null,"See CPT",794.96699999999998,794.96699999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27734,null,"See CPT",1147.578,1147.578,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27740,null,"See CPT",1233.27,1233.27,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27742,null,"See CPT",1351.9650000000001,1351.9650000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27745,null,"See CPT",1323.0150000000001,1323.0150000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27750,null,"See CPT",619.53,571.47299999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27752,null,"See CPT",947.82299999999998,863.28899999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27756,null,"See CPT",1006.881,1006.881,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27758,null,"See CPT",1555.194,1555.194,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27759,null,"See CPT",1727.7359999999999,1727.7359999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27760,null,"See CPT",595.79099999999994,547.15499999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27762,null,"See CPT",849.97199999999998,764.85900000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27766,null,"See CPT",1058.991,1058.991,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27767,null,"See CPT",522.25799999999992,517.04700000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27768,null,"See CPT",786.28200000000004,786.28200000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27769,null,"See CPT",1272.0629999999999,1272.0629999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27780,null,"See CPT",553.524,506.625,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27781,null,"See CPT",772.38599999999997,707.53800000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27784,null,"See CPT",1230.954,1230.954,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27786,null,"See CPT",562.78800000000001,512.41499999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27788,null,"See CPT",756.17399999999998,681.48299999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27792,null,"See CPT",1126.155,1126.155,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27808,null,"See CPT",601.00200000000007,544.83899999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27810,null,"See CPT",836.65499999999997,750.38400000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27814,null,"See CPT",1332.8579999999999,1332.8579999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27816,null,"See CPT",589.42200000000003,520.52099999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27818,null,"See CPT",867.34199999999998,768.91199999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27822,null,"See CPT",1532.6129999999998,1532.6129999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27823,null,"See CPT",1721.367,1721.367,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27824,null,"See CPT",567.99900000000002,541.36500000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27825,null,"See CPT",958.245,859.23599999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27826,null,"See CPT",1493.82,1493.82,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27827,null,"See CPT",1953.546,1953.546,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27828,null,"See CPT",2309.6309999999999,2309.6309999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27829,null,"See CPT",1243.692,1243.692,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27830,null,"See CPT",691.90499999999997,635.74199999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27831,null,"See CPT",717.38099999999997,717.38099999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27832,null,"See CPT",1318.383,1318.383,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27840,null,"See CPT",672.21899999999994,672.21899999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27842,null,"See CPT",867.92099999999994,867.92099999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27846,null,"See CPT",1244.8499999999999,1244.8499999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27848,null,"See CPT",1382.6519999999998,1382.6519999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27860,null,"See CPT",291.81599999999997,291.81599999999997,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27870,null,"See CPT",1753.7909999999999,1753.7909999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27871,null,"See CPT",1198.53,1198.53,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27880,null,"See CPT",1542.4559999999999,1542.4559999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27881,null,"See CPT",1471.239,1471.239,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27882,null,"See CPT",1015.5659999999999,1015.5659999999999,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27884,null,"See CPT",990.09,990.09,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27886,null,"See CPT",1123.8389999999999,1123.8389999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27888,null,"See CPT",1127.3129999999999,1127.3129999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27889,null,"See CPT",1088.52,1088.52,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27892,null,"See CPT",929.87399999999991,929.87399999999991,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27893,null,"See CPT",1071.1499999999999,1071.1499999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27894,null,"See CPT",1432.4459999999999,1432.4459999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27899,null,"See CPT","By Report","By Report","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[28001,null,"See CPT",490.41300000000001,289.5,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[28002,null,"See CPT",772.96499999999992,543.68100000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[28003,null,"See CPT",1234.4279999999999,968.66700000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28005,null,"See CPT",992.40600000000006,992.40600000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28008,null,"See CPT",774.12299999999993,510.09899999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28010,null,"See CPT",407.61599999999999,360.13799999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28011,null,"See CPT",549.471,483.46499999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28020,null,"See CPT",984.3,636.32100000000003,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28022,null,"See CPT",876.60599999999999,564.52499999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28024,null,"See CPT",821.601,525.73199999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28035,null,"See CPT",948.98099999999999,617.79300000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28039,null,"See CPT",884.13299999999992,598.68599999999992,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28041,null,"See CPT",777.59699999999998,777.59699999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28043,null,"See CPT",697.69500000000005,449.88299999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28045,null,"See CPT",865.02599999999995,599.26499999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28046,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]
[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]
[28050,null,"See CPT",749.80499999999995,481.149,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28052,null,"See CPT",800.75699999999995,492.15,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28054,null,"See CPT",665.27099999999996,404.721,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28055,null,"See CPT",666.42899999999997,666.42899999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28060,null,"See CPT",937.40100000000007,625.32000000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28062,null,"See CPT",1032.357,699.43200000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28070,null,"See CPT",941.45400000000006,609.6869999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28072,null,"See CPT",876.02700000000004,556.99799999999993,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28080,null,"See CPT",952.45499999999993,650.79600000000005,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28086,null,"See CPT",971.56200000000001,619.53,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28088,null,"See CPT",803.07299999999998,488.67599999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28090,null,"See CPT",838.39200000000005,532.101,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28092,null,"See CPT",759.06899999999996,466.67400000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28100,null,"See CPT",1107.627,727.803,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28102,null,"See CPT",1065.9390000000001,1065.9390000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28103,null,"See CPT",669.32400000000007,669.32400000000007,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28104,null,"See CPT",947.82299999999998,613.16099999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28106,null,"See CPT",734.17199999999991,734.17199999999991,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28107,null,"See CPT",1020.198,661.79699999999991,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[28108,null,"See CPT",782.80799999999999,497.36099999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28110,null,"See CPT",830.28599999999994,501.99299999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28111,null,"See CPT",870.23699999999997,557.577,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28112,null,"See CPT",873.13199999999995,540.20699999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28113,null,"See CPT",1049.1480000000001,737.06700000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28114,null,"See CPT",1890.4349999999999,1445.7629999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28116,null,"See CPT",1359.492,1000.5120000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28118,null,"See CPT",1080.414,728.38199999999995,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28119,null,"See CPT",937.9799999999999,627.05700000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28120,null,"See CPT",1204.8989999999999,860.97299999999996,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28122,null,"See CPT",1056.0959999999998,756.75300000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28124,null,"See CPT",854.60399999999993,576.1049999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28126,null,"See CPT",702.327,426.72300000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28130,null,"See CPT",1074.0450000000001,1074.0450000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28140,null,"See CPT",1030.6200000000001,744.01499999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28150,null,"See CPT",755.59500000000003,481.72800000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28153,null,"See CPT",737.06700000000001,458.56799999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28160,null,"See CPT",744.01499999999999,463.2,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,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]
[28173,null,"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,"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,"See CPT",455.673,231.6,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[28192,null,"See CPT",834.33899999999994,539.62800000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28193,null,"See CPT",940.875,635.74199999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28200,null,"See CPT",887.60699999999997,563.36699999999996,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28202,null,"See CPT",1066.518,740.54099999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[28208,null,"See CPT",871.97400000000005,552.36599999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28210,null,"See CPT",1069.413,737.06700000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[28220,null,"See CPT",807.12599999999998,523.41599999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28222,null,"See CPT",931.61099999999999,620.10900000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28225,null,"See CPT",752.69999999999993,458.56799999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28226,null,"See CPT",1125.576,695.95799999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28230,null,"See CPT",779.33400000000006,489.83400000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28232,null,"See CPT",688.43100000000004,416.88,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28234,null,"See CPT",740.54099999999994,463.2,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28238,null,"See CPT",1180.002,835.49699999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28240,null,"See CPT",803.65200000000004,508.36199999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28250,null,"See CPT",1031.1989999999998,695.37900000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28260,null,"See CPT",1245.4290000000001,898.029,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28261,null,"See CPT",2135.931,1625.8319999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28262,null,"See CPT",2449.1699999999996,1932.1229999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28264,null,"See CPT",1609.62,1202.0040000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28270,null,"See CPT",879.50099999999998,579.57899999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28272,null,"See CPT",694.221,433.09200000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28280,null,"See CPT",913.08299999999997,598.68599999999992,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28285,null,"See CPT",960.56099999999992,661.79699999999991,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28286,null,"See CPT",793.2299999999999,510.678,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28288,null,"See CPT",1089.6779999999999,753.85799999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28289,null,"See CPT",1258.7459999999999,793.2299999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28291,null,"See CPT",1296.9599999999998,851.12999999999988,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28292,null,"See CPT",1267.431,831.44399999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28295,null,"See CPT",2017.2360000000001,1075.203,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28296,null,"See CPT",1627.569,884.13299999999992,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28297,null,"See CPT",1891.5930000000001,1041.6209999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28298,null,"See CPT",1517.559,864.447,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28299,null,"See CPT",1827.3239999999998,1010.3549999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28300,null,"See CPT",1125.576,1125.576,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28302,null,"See CPT",1246.008,1246.008,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28304,null,"See CPT",1466.607,1049.7269999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28305,null,"See CPT",1167.2639999999999,1167.2639999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28306,null,"See CPT",1079.8349999999998,690.16800000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28307,null,"See CPT",1097.7840000000001,714.48599999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28308,null,"See CPT",1024.83,664.69200000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28309,null,"See CPT",1530.297,1530.297,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28310,null,"See CPT",981.40499999999997,624.16199999999992,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28312,null,"See CPT",917.71499999999992,558.15600000000006,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28313,null,"See CPT",951.29699999999991,623.58299999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28315,null,"See CPT",864.447,565.68299999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28320,null,"See CPT",1068.2549999999999,1068.2549999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28322,null,"See CPT",1402.9169999999999,999.93299999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28340,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]
[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]
[28344,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]
[28345,null,"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,"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,"See CPT",439.46099999999996,404.721,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28405,null,"See CPT",694.8,623.00400000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28406,null,"See CPT",976.77300000000002,976.77300000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28415,null,"See CPT",1953.546,1953.546,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28420,null,"See CPT",2256.9419999999996,2256.9419999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28430,null,"See CPT",429.03899999999999,372.87600000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28435,null,"See CPT",591.15899999999999,518.78399999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28436,null,"See CPT",863.86799999999994,863.86799999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28445,null,"See CPT",1773.4769999999999,1773.4769999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[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,2,29]
[28450,null,"See CPT",376.34999999999997,337.55700000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28455,null,"See CPT",512.41499999999996,453.93599999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28456,null,"See CPT",645.00599999999997,645.00599999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28465,null,"See CPT",1098.3629999999998,1098.3629999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28470,null,"See CPT",389.66700000000003,363.61200000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28475,null,"See CPT",453.35699999999997,396.61499999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28476,null,"See CPT",682.0619999999999,682.0619999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28485,null,"See CPT",978.50999999999988,978.50999999999988,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28490,null,"See CPT",251.86499999999998,218.86199999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28495,null,"See CPT",316.71299999999997,260.55,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28496,null,"See CPT",834.91800000000001,430.19699999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28505,null,"See CPT",1175.9489999999998,859.81499999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28510,null,"See CPT",214.809,211.33499999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28515,null,"See CPT",289.5,249.54899999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28525,null,"See CPT",1024.83,703.48500000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28530,null,"See CPT",202.65,174.858,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28531,null,"See CPT",605.63400000000001,313.23899999999998,"090",0.1,0.69,0.21,0,2,1,1,2,0,null,"R",null,null,2,29]
[28540,null,"See CPT",342.18900000000002,305.71199999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28545,null,"See CPT",547.73400000000004,476.517,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28546,null,"See CPT",1081.5719999999999,617.21399999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28555,null,"See CPT",1526.2439999999999,1133.6819999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28570,null,"See CPT",418.61700000000002,346.82100000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28575,null,"See CPT",669.32400000000007,596.37,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28576,null,"See CPT",675.69299999999998,675.69299999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28585,null,"See CPT",1539.5609999999999,1183.4760000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28600,null,"See CPT",387.351,326.55599999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28605,null,"See CPT",606.21299999999997,536.73299999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28606,null,"See CPT",664.11300000000006,664.11300000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28615,null,"See CPT",1437.078,1437.078,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28630,null,"See CPT",274.44600000000003,191.07,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28635,null,"See CPT",315.55500000000001,233.916,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28636,null,"See CPT",559.31399999999996,343.92599999999999,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R",null,null,2,29]
[28645,null,"See CPT",1165.5269999999998,840.70799999999997,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28660,null,"See CPT",216.54600000000002,160.96199999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[28665,null,"See CPT",261.70799999999997,217.125,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28666,null,"See CPT",301.65899999999999,301.65899999999999,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R",null,null,2,29]
[28675,null,"See CPT",1022.514,705.22199999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28705,null,"See CPT",2096.5590000000002,2096.5590000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28715,null,"See CPT",1633.3589999999999,1633.3589999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28725,null,"See CPT",1349.07,1349.07,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28730,null,"See CPT",1273.2209999999998,1273.2209999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28735,null,"See CPT",1347.912,1347.912,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28737,null,"See CPT",1179.423,1179.423,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28740,null,"See CPT",1482.24,1070.5709999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28750,null,"See CPT",1412.181,1006.881,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28755,null,"See CPT",918.29399999999998,580.73699999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28760,null,"See CPT",1364.1239999999998,981.40499999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28800,null,"See CPT",915.399,915.399,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28805,null,"See CPT",1223.4269999999999,1223.4269999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28810,null,"See CPT",735.32999999999993,735.32999999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28820,null,"See CPT",546.57599999999991,307.44899999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28825,null,"See CPT",534.99599999999998,297.60599999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28890,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]
[28899,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[29000,null,"See CPT",613.16099999999994,336.39899999999994,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29010,null,"See CPT",474.78,273.86700000000002,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29015,null,"See CPT",510.09899999999999,309.18599999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29035,null,"See CPT",446.988,246.07499999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29040,null,"See CPT",509.52000000000004,296.44799999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29044,null,"See CPT",499.09799999999996,286.02600000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29046,null,"See CPT",547.15499999999997,321.92399999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29049,null,"See CPT",172.542,119.274,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29055,null,"See CPT",378.666,232.17899999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29058,null,"See CPT",213.65099999999998,160.96199999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29065,null,"See CPT",167.91,116.958,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29075,null,"See CPT",151.69800000000001,107.11500000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29085,null,"See CPT",165.59399999999999,115.221,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29086,null,"See CPT",130.85399999999998,83.954999999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29105,null,"See CPT",144.17100000000002,70.637999999999991,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29125,null,"See CPT",115.221,68.321999999999989,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29126,null,"See CPT",133.749,83.375999999999991,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29130,null,"See CPT",71.795999999999992,49.214999999999996,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29131,null,"See CPT",90.903000000000006,58.478999999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29200,null,"See CPT",58.478999999999999,31.845000000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29240,null,"See CPT",53.847000000000001,31.266000000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29260,null,"See CPT",52.11,33.002999999999993,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29280,null,"See CPT",50.951999999999998,33.002999999999993,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29305,null,"See CPT",430.19699999999995,270.97199999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29325,null,"See CPT",475.93800000000005,304.55399999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29345,null,"See CPT",235.65300000000002,171.96299999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29355,null,"See CPT",248.39099999999999,184.70099999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29358,null,"See CPT",278.49899999999997,177.17400000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29365,null,"See CPT",212.49299999999999,149.38200000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29405,null,"See CPT",138.95999999999998,100.167,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29425,null,"See CPT",132.01199999999997,93.798000000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29435,null,"See CPT",198.59700000000001,138.381,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29440,null,"See CPT",73.533000000000001,48.056999999999995,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29445,null,"See CPT",225.23099999999999,171.96299999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29450,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[29505,null,"See CPT",154.01400000000001,89.165999999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29515,null,"See CPT",123.90600000000001,84.533999999999992,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29520,null,"See CPT",63.690000000000005,31.845000000000002,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29530,null,"See CPT",53.268000000000001,31.266000000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29540,null,"See CPT",48.056999999999995,29.529,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29550,null,"See CPT",33.002999999999993,19.106999999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29580,null,"See CPT",114.642,45.741,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29581,null,"See CPT",162.11999999999998,46.32,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29584,null,"See CPT",153.435,27.212999999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29700,null,"See CPT",108.85199999999999,56.741999999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29705,null,"See CPT",110.00999999999999,77.007000000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29710,null,"See CPT",211.91400000000002,141.27599999999998,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29720,null,"See CPT",148.22399999999999,74.111999999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29730,null,"See CPT",108.27300000000001,74.691000000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29740,null,"See CPT",171.38399999999999,118.116,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29750,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[29799,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[29800,null,"See CPT",926.4,926.4,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[29805,null,"See CPT",823.91700000000003,823.91700000000003,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[29827,null,"See CPT",1852.2209999999998,1852.2209999999998,"090",0.1,0.69,0.21,0,3,1,2,1,0,29805,"R",null,"Y-UR",2,29]
[29840,null,"See CPT",790.33500000000004,790.33500000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[29856,null,"See CPT",1710.9449999999999,1710.9449999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[29875,null,"See CPT",867.92099999999994,867.92099999999994,"090",0.1,0.69,0.21,0,3,1,0,0,0,29870,"R",null,"Y-UR",2,29]
[29883,null,"See CPT",1455.0269999999998,1455.0269999999998,"090",0.1,0.69,0.21,0,3,1,0,0,0,29870,"R",null,"Y-UR",2,29]
[29885,null,"See CPT",1313.751,1313.751,"090",0.1,0.69,0.21,0,3,1,2,1,0,29870,"R",null,"Y-UR",2,29]
[29895,null,"See CPT",811.75799999999992,811.75799999999992,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29906,null,"See CPT",1141.788,1141.788,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[30118,null,"See CPT",1433.0249999999999,1433.0249999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,1,1,0,null,"R",null,null,2,29]
[30200,null,"See CPT",210.756,103.062,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[30435,null,"See CPT",2410.9560000000001,2410.9560000000001,"090",0.1,0.76,0.14000000000000001,0,2,0,2,0,0,null,"R",null,null,2,29]
[30560,null,"See CPT",603.89699999999993,269.81400000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[30801,null,"See CPT",425.56499999999994,282.55199999999996,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R",null,null,2,29]
[30920,null,"See CPT",1576.617,1576.617,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[31050,null,"See CPT",945.50699999999983,945.50699999999983,"090",0.1,0.76,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[31087,null,"See CPT",2014.9199999999998,2014.9199999999998,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,29]
[31237,null,"See CPT",467.83199999999999,277.34100000000001,"000",0,0,0,0,3,1,1,0,0,31231,"R",null,null,2,29]
[31287,null,"See CPT",349.137,349.137,"000",0,0,0,0,3,1,0,0,0,31231,"R",null,null,2,29]
[31295,null,"See CPT",3603.6959999999999,273.86700000000002,"000",0,0,0,0,3,1,2,0,0,31231,"R",null,null,2,29]
[31368,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]
[31500,null,"See CPT",240.28500000000003,240.28500000000003,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[31526,null,"See CPT",272.13,272.13,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[31530,null,"See CPT",343.92599999999999,343.92599999999999,"000",0,0,0,0,3,0,1,0,0,31525,"R",null,null,2,29]
[31546,null,"See CPT",946.08600000000001,946.08600000000001,"000",0,0,0,0,3,1,1,0,0,31526,"R",null,null,2,29]
[31573,null,"See CPT",522.83699999999999,257.65500000000003,"000",0,0,0,0,3,1,0,0,0,31575,"R",null,"Y-CM",2,29]
[31599,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[31611,null,"See CPT",980.24699999999996,980.24699999999996,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31629,null,"See CPT",855.18299999999999,318.45,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,null,2,29]
[31636,null,"See CPT",374.03399999999999,374.03399999999999,"000",0,0,0,0,3,0,1,0,0,31622,"R",null,null,2,29]
[31649,null,"See CPT",115.221,115.221,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[31654,null,"See CPT",221.75700000000001,114.642,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[31750,null,"See CPT",2504.7539999999999,2504.7539999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31805,null,"See CPT",1397.7059999999999,1397.7059999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32120,null,"See CPT",1491.5040000000001,1491.5040000000001,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32160,null,"See CPT",1359.492,1359.492,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32480,null,"See CPT",2512.8599999999997,2512.8599999999997,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32503,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]
[32554,null,"See CPT",436.56599999999997,152.27699999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[32560,null,"See CPT",489.83400000000006,130.27500000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[32608,null,"See CPT",639.79500000000007,639.79500000000007,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[32661,null,"See CPT",1361.808,1361.808,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32668,null,"See CPT",263.44499999999999,263.44499999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32820,null,"See CPT",2265.627,2265.627,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32960,null,"See CPT",224.65199999999999,155.751,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33018,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[33020,null,"See CPT",1405.8120000000001,1405.8120000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33207,null,"See CPT",827.97,827.97,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,2,0,null,"R",null,"Y-CM",2,29]
[33215,null,"See CPT",537.3119999999999,537.3119999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33227,null,"See CPT",589.42200000000003,589.42200000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33236,null,"See CPT",1338.069,1338.069,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,2,0,null,"R",null,"Y-CM",2,29]
[33254,null,"See CPT",2304.4199999999996,2304.4199999999996,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33270,null,"See CPT",977.93100000000004,977.93100000000004,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33289,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,"Y-CM",2,29]
[33305,null,"See CPT",6896.4690000000001,6896.4690000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33361,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,2,1,null,"X",null,null,2,29]
[33390,null,"See CPT",3262.665,3262.665,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[33417,null,"See CPT",2830.152,2830.152,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33430,null,"See CPT",4737.9569999999994,4737.9569999999994,"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",3932.5680000000002,3932.5680000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33504,null,"See CPT",2490.8580000000002,2490.8580000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33514,null,"See CPT",4431.0869999999995,4431.0869999999995,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33518,null,"See CPT",691.32599999999991,691.32599999999991,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33536,null,"See CPT",4457.1419999999998,4457.1419999999998,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33610,null,"See CPT",3012.5369999999998,3012.5369999999998,"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",2929.7400000000002,2929.7400000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33681,null,"See CPT",3128.9159999999997,3128.9159999999997,"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",3435.2069999999999,3435.2069999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33750,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]
[33774,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]
[33777,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]
[33800,null,"See CPT","Not Covered","Not Covered","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"X",null,null,2,29]
[33845,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]
[33875,null,"See CPT",4608.2610000000004,4608.2610000000004,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[33891,null,"See CPT",1600.9349999999999,1600.9349999999999,"000",0,0,0,0,2,1,2,2,0,null,"R",null,null,2,29]
[33929,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,2,0,0,null,"N",null,"Y-UR",2,29]
[33948,null,"See CPT",404.721,404.721,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33958,null,"See CPT",310.34399999999999,310.34399999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[33970,null,"See CPT",595.21199999999999,595.21199999999999,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33979,null,"See CPT",3269.0340000000001,3269.0340000000001,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33982,null,"See CPT",3281.7719999999999,3281.7719999999999,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33992,null,"See CPT",319.029,319.029,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[34111,null,"See CPT",1012.092,1012.092,"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",1708.6290000000001,1708.6290000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[34705,null,"See CPT",2564.9699999999998,2564.9699999999998,"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",734.75099999999998,734.75099999999998,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[34834,null,"See CPT",214.809,214.809,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-CM",2,29]
[34847,null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,2,2,0,null,"N",null,null,2,29]
[35002,null,"See CPT",1902.0150000000001,1902.0150000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35102,null,"See CPT",3147.444,3147.444,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35132,null,"See CPT",2725.9319999999998,2725.9319999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35201,null,"See CPT",1598.04,1598.04,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35231,null,"See CPT",2142.2999999999997,2142.2999999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35301,null,"See CPT",1901.4360000000001,1901.4360000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35303,null,"See CPT",2074.5569999999998,2074.5569999999998,"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",531.52199999999993,531.52199999999993,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35508,null,"See CPT",2215.8330000000001,2215.8330000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35535,null,"See CPT",3173.4990000000003,3173.4990000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35539,null,"See CPT",3654.6479999999997,3654.6479999999997,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35572,null,"See CPT",577.84199999999998,577.84199999999998,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[35612,null,"See CPT",1747.422,1747.422,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35642,null,"See CPT",1653.0450000000001,1653.0450000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35646,null,"See CPT",2871.261,2871.261,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35693,null,"See CPT",1400.0219999999999,1400.0219999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35697,null,"See CPT",245.49600000000001,245.49600000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-CM",2,29]
[35884,null,"See CPT",2067.6089999999999,2067.6089999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35907,null,"See CPT",3185.6579999999999,3185.6579999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[36100,null,"See CPT",1097.7840000000001,264.02399999999994,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[36218,null,"See CPT",402.40499999999997,83.954999999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[36248,null,"See CPT",234.49499999999998,81.059999999999988,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[36261,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]
[36406,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[36455,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[36483,null,"See CPT",255.339,149.96099999999998,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM",2,29]
[36512,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",1958.7569999999998,570.31499999999994,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[36573,null,"See CPT",752.12099999999998,142.434,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[36585,null,"See CPT",2131.8780000000002,466.67400000000004,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[36596,null,"See CPT",215.96699999999998,74.691000000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36625,null,"See CPT",178.33199999999999,178.33199999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[36820,null,"See CPT",1218.2159999999999,1218.2159999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[36860,null,"See CPT",435.40799999999996,187.017,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36907,null,"See CPT",1222.269,245.49600000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[37186,null,"See CPT",2445.1169999999997,410.51099999999997,"000",0,0,0,0,0,2,1,2,0,null,"R",null,null,2,29]
[37211,null,"See CPT",649.63800000000003,649.63800000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[37221,null,"See CPT",6804.4079999999994,829.70699999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37231,null,"See CPT",25565.166000000001,1265.694,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37239,null,"See CPT",3598.4849999999997,254.76000000000002,"000",0,0,0,0,0,1,0,0,0,null,"R",null,null,2,29]
[37243,null,"See CPT",17790.932999999997,940.29599999999994,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[37565,null,"See CPT",1263.3779999999999,1263.3779999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,0,1,0,null,"R",null,null,2,29]
[37617,null,"See CPT",2258.1,2258.1,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[37765,null,"See CPT",784.54500000000007,460.30500000000001,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[38100,null,"See CPT",1975.5479999999998,1975.5479999999998,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,null,2,29]
[38209,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[38230,null,"See CPT",347.4,347.4,"000",0,0,0,0,2,0,0,0,0,null,"R",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",1177.107,1177.107,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[38555,null,"See CPT",1768.845,1768.845,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,null,2,29]
[38700,null,"See CPT",1408.7069999999999,1408.7069999999999,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[38790,null,"See CPT",139.53900000000002,139.53900000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[39200,null,"See CPT",1481.0819999999999,1481.0819999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[39599,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,null,2,29]
[40654,null,"See CPT",1039.884,737.06700000000001,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[40801,null,"See CPT",531.52199999999993,347.97899999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[40806,null,"See CPT",186.43800000000002,49.214999999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[40845,null,"See CPT",2653.5569999999998,2117.4029999999998,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[41005,null,"See CPT",397.19400000000002,193.965,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41100,null,"See CPT",343.34699999999998,189.91199999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[41115,null,"See CPT",495.62400000000002,262.28700000000003,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41252,null,"See CPT",601.58100000000002,367.66499999999996,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41800,null,"See CPT",560.47199999999998,281.97300000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[41850,null,"See CPT",71.528577120000008,71.528577120000008,"000",0,0,0,0,2,0,0,0,0,null,"F",null,"Y-CM",2,29]
[41874,null,"See CPT",707.53800000000001,429.03899999999999,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[42210,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]
[42226,null,"See CPT",1639.7280000000001,1639.7280000000001,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[42281,null,"See CPT",409.35300000000001,281.39400000000001,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42409,null,"See CPT",724.32899999999995,405.87899999999996,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[42510,null,"See CPT",1102.4159999999999,1102.4159999999999,"090",0.09,0.81,0.1,0,2,2,2,1,0,null,"R",null,null,2,29]
[42699,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,null,2,29]
[42804,null,"See CPT",391.98299999999995,213.072,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[42836,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]
[42955,null,"See CPT",1409.2860000000001,1409.2860000000001,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[42970,null,"See CPT",733.59299999999996,733.59299999999996,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[43030,null,"See CPT",914.82,914.82,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43124,null,"See CPT",6448.9019999999991,6448.9019999999991,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43191,null,"See CPT",269.81400000000002,269.81400000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[43205,null,"See CPT",240.28500000000003,240.28500000000003,"000",0,0,0,0,3,0,1,0,0,43200,"R",null,"Y-CM",2,29]
[43213,null,"See CPT",2421.3780000000002,442.935,"000",0,0,0,0,3,0,1,0,0,43200,"R",null,null,2,29]
[43236,null,"See CPT",742.85699999999997,236.232,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43248,null,"See CPT",759.06899999999996,282.55199999999996,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43252,null,"See CPT",618.37199999999996,287.76299999999998,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,"Y-CM",2,29]
[43259,null,"See CPT",383.87700000000001,383.87700000000001,"000",0,0,0,0,3,0,1,0,0,43235,"R",null,null,2,29]
[43278,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,43260,"X",null,null,2,29]
[43282,null,"See CPT",2962.7429999999999,2962.7429999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",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]
[43328,null,"See CPT",1914.174,1914.174,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43352,null,"See CPT",1825.008,1825.008,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43415,null,"See CPT",4354.08,4354.08,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43500,null,"See CPT",1353.702,1353.702,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43611,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]
[43648,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[43659,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[43775,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]
[43840,null,"See CPT",2332.7909999999997,2332.7909999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43850,null,"See CPT",2796.5699999999997,2796.5699999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43881,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[44050,null,"See CPT",1607.883,1607.883,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44125,null,"See CPT",2018.9729999999997,2018.9729999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44135,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,29]
[44144,null,"See CPT",3025.2750000000001,3025.2750000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44202,null,"See CPT",2374.4789999999998,2374.4789999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44211,null,"See CPT",3610.0650000000001,3610.0650000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44227,null,"See CPT",2839.9949999999999,2839.9949999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44364,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,0,0,0,44360,"X",null,null,2,29]
[44376,null,"See CPT",483.46499999999997,483.46499999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[44384,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,44380,"X",null,null,2,29]
[44392,null,"See CPT",703.48500000000001,338.71499999999997,"000",0,0,0,0,3,0,1,0,0,44388,"R",null,"Y-CM",2,29]
[44603,null,"See CPT",2767.62,2767.62,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44626,null,"See CPT",2724.1949999999997,2724.1949999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44701,null,"See CPT",288.92099999999999,288.92099999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[44850,null,"See CPT",1287.117,1287.117,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[45112,null,"See CPT",3173.4990000000003,3173.4990000000003,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45123,null,"See CPT",1908.963,1908.963,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45171,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]
[45308,null,"See CPT",374.03399999999999,144.17100000000002,"000",0,0,0,0,3,0,1,0,0,45300,"R",null,"Y-CM",2,29]
[45335,null,"See CPT",543.10199999999998,113.48399999999999,"000",0,0,0,0,3,0,1,0,0,45330,"R",null,"Y-CM",2,29]
[45346,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,45330,"X",null,null,2,29]
[45380,null,"See CPT",805.38900000000001,342.18900000000002,"000",0,0,0,0,3,0,1,0,0,45378,"R",null,"Y-CM",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]
[45541,null,"See CPT",1634.5170000000001,1634.5170000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45563,null,"See CPT",2870.6819999999998,2870.6819999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45900,null,"See CPT",369.40199999999999,369.40199999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[46070,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]
[46261,null,"See CPT",914.82,914.82,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46288,null,"See CPT",970.98299999999995,970.98299999999995,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46601,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,46600,"X",null,null,2,29]
[46707,null,"See CPT",884.71199999999999,884.71199999999999,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[46750,null,"See CPT",1316.646,1316.646,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46760,null,"See CPT",1894.4879999999998,1894.4879999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46917,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]
[47015,null,"See CPT",2016.6569999999999,2016.6569999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47125,null,"See CPT",5260.2149999999992,5260.2149999999992,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47300,null,"See CPT",1961.0729999999999,1961.0729999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47370,null,"See CPT",2148.6689999999999,2148.6689999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47490,null,"See CPT",579,579,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[47536,null,"See CPT",1277.8530000000001,221.75700000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[47554,null,"See CPT",876.02700000000004,876.02700000000004,"000",0,0,0,0,3,0,1,1,0,47552,"R",null,null,2,29]
[47562,null,"See CPT",1138.3140000000001,1138.3140000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[47715,null,"See CPT",2300.9459999999999,2300.9459999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47741,null,"See CPT",2548.1789999999996,2548.1789999999996,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48105,null,"See CPT",4869.9690000000001,4869.9690000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48145,null,"See CPT",2808.15,2808.15,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48520,null,"See CPT",1898.5409999999999,1898.5409999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",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",1886.9610000000002,1886.9610000000002,"090",0.09,0.81,0.1,0,2,0,1,1,0,null,"R",null,null,2,29]
[49083,null,"See CPT",556.99799999999993,180.648,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[49324,null,"See CPT",670.48199999999997,670.48199999999997,"010",0.1,0.8,0.1,0,3,0,2,2,0,49320,"R",null,null,2,29]
[49329,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[49426,null,"See CPT",1158,1158,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[49429,null,"See CPT",789.75599999999997,789.75599999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[49491,null,"See CPT","Not Covered","Not Covered","090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X",null,null,2,29]
[49505,null,"See CPT",904.97699999999998,904.97699999999998,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49565,null,"See CPT",1324.752,1324.752,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49585,null,"See CPT",777.01800000000003,777.01800000000003,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[49653,null,"See CPT",1606.146,1606.146,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[49656,null,"See CPT",1577.1959999999999,1577.1959999999999,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[50075,null,"See CPT","Not Covered","Not Covered","090",0.08,0.83,0.09,0,2,1,2,1,0,null,"X",null,null,2,29]
[50100,null,"See CPT","Not Covered","Not Covered","090",0.08,0.83,0.09,0,2,1,2,1,0,null,"X",null,null,2,29]
[50225,null,"See CPT",2077.4520000000002,2077.4520000000002,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50323,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,0,null,"N",null,"Y-CM",2,29]
[50385,null,"See CPT",2054.2919999999999,373.45499999999998,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[50400,null,"See CPT",2005.077,2005.077,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50520,null,"See CPT",1995.8129999999999,1995.8129999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[50545,null,"See CPT",2313.6840000000002,2313.6840000000002,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,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]
[50574,null,"See CPT",970.98299999999995,970.98299999999995,"000",0,0,0,0,3,1,0,0,0,50570,"R",null,null,2,29]
[50605,null,"See CPT",1719.0509999999999,1719.0509999999999,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50690,null,"See CPT",206.70299999999997,119.274,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[50725,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]
[50760,null,"See CPT",1964.547,1964.547,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50920,null,"See CPT",1535.508,1535.508,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[50953,null,"See CPT",711.59099999999989,561.63,"000",0,0,0,0,3,1,0,0,0,50951,"R",null,"Y-CM",2,29]
[51030,null,"See CPT",831.44399999999996,831.44399999999996,"090",0.08,0.83,0.09,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[51040,null,"See CPT",512.99399999999991,512.99399999999991,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[51535,null,"See CPT",1360.0709999999999,1360.0709999999999,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[51585,null,"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]
[51701,null,"See CPT",83.375999999999991,44.582999999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[51715,null,"See CPT",668.16599999999994,345.66299999999995,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[51729,26,"See CPT",217.125,217.125,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51784,26,"See CPT",64.847999999999999,64.847999999999999,"000",0,0,0,1,2,0,1,0,0,null,"R",null,null,2,29]
[51797,26,"See CPT",68.900999999999996,68.900999999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,29]
[51798,null,"See CPT",19.686,19.686,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,29]
[51960,null,"See CPT",2404.587,2404.587,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[52005,null,"See CPT",570.89400000000001,229.863,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52250,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,1,0,0,52000,"X",null,null,2,29]
[52283,null,"See CPT",634.005,347.4,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52318,null,"See CPT",812.91599999999994,812.91599999999994,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,null,2,29]
[52330,null,"See CPT",1132.5239999999999,452.77800000000002,"000",0,0,0,0,3,1,1,0,0,52000,"R",null,null,2,29]
[52402,null,"See CPT",457.41,457.41,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,"Y-CM",2,29]
[52441,null,"See CPT",2634.45,361.29599999999999,"000",0,0,0,0,3,0,1,0,0,52000,"R",null,"Y-CM",2,29]
[53020,null,"See CPT",166.75199999999998,166.75199999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[53200,null,"See CPT",276.18299999999999,244.33799999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[53400,null,"See CPT",1395.9689999999998,1395.9689999999998,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53431,null,"See CPT",2001.6030000000001,2001.6030000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53460,null,"See CPT",803.07299999999998,803.07299999999998,"090",0.08,0.83,0.09,0,2,0,0,0,0,null,"R",null,null,2,29]
[53510,null,"See CPT",1105.8900000000001,1105.8900000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[53899,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[54015,null,"See CPT",532.67999999999995,532.67999999999995,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[54100,null,"See CPT",363.61200000000002,207.86099999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[54160,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]
[54240,26,"See CPT",111.747,111.747,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,29]
[54308,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]
[54344,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]
[54360,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]
[54430,null,"See CPT",1119.2069999999999,1119.2069999999999,"090",0.1,0.8,0.1,0,2,2,2,0,0,null,"R",null,null,2,29]
[54438,null,"See CPT",2322.3689999999997,2322.3689999999997,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[54530,null,"See CPT",891.66,891.66,"090",0.1,0.8,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[54680,null,"See CPT",1373.9670000000001,1373.9670000000001,"090",0.1,0.8,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[54901,null,"See CPT",1841.799,1841.799,"090",0.1,0.8,0.1,0,2,2,0,0,0,null,"R",null,"Y-CM",2,29]
[55120,null,"See CPT",625.32000000000005,625.32000000000005,"090",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[55535,null,"See CPT",756.17399999999998,756.17399999999998,"090",0.1,0.8,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[55559,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[55831,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]
[55845,null,"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]
[55875,null,"See CPT","Not Covered","Not Covered","090",0.1,0.8,0.1,0,2,0,0,0,0,null,"X",null,null,2,29]
[56441,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]
[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]
[56810,null,"See CPT",476.517,476.517,"010",0.1,0.8,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[57105,null,"See CPT",311.50200000000001,256.49699999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[57135,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]
[57230,null,"See CPT",741.12,741.12,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57260,null,"See CPT",1368.7560000000001,1368.7560000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57284,null,"See CPT",1461.396,1461.396,"090",0.08,0.83,0.09,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[57305,null,"See CPT",1701.1019999999999,1701.1019999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57410,null,"See CPT",184.12200000000001,184.12200000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[57455,null,"See CPT",287.18399999999997,189.91199999999998,"000",0,0,0,0,3,0,1,0,0,57452,"R",null,"Y-CM",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]
[57700,null,"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,0,0,0,0,null,"X",null,null,2,29]
[58152,null,"See CPT",2175.3029999999999,2175.3029999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58180,null,"See CPT",1681.4159999999999,1681.4159999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58270,null,"See CPT",1571.4059999999999,1571.4059999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58323,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[58520,null,"See CPT",1408.1279999999999,1408.1279999999999,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58550,null,"See CPT",1549.9829999999999,1549.9829999999999,"090",0.12,0.74,0.14000000000000001,0,3,0,2,2,0,49320,"R",null,"Y-CM",2,29]
[58563,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,3,0,0,2,0,58555,"X",null,null,2,29]
[58579,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[58674,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]
[58679,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[58800,null,"See CPT","Not Covered","Not Covered","090",0.12,0.74,0.14000000000000001,0,2,2,1,0,0,null,"X",null,null,2,29]
[58951,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]
[58960,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]
[59025,null,"See CPT",86.271000000000001,86.271000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59100,null,"See CPT","Not Covered","Not Covered","090",0.17,0.6,0.23,0,2,0,2,1,0,null,"X",null,null,2,29]
[59151,null,"See CPT",1345.0170000000001,1345.0170000000001,"090",0.17,0.6,0.23,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[59425,null,"See CPT",982.56299999999987,750.96299999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59426,null,"See CPT",1797.2159999999999,1375.704,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59614,null,"See CPT",1974.9689999999998,1974.9689999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59851,null,"See CPT",747.48900000000003,747.48900000000003,"090",0.17,0.6,0.23,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59871,null,"See CPT",229.28399999999999,229.28399999999999,"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]
[60505,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]
[60605,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]
[61105,null,"See CPT",802.49399999999991,802.49399999999991,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R",null,null,2,29]
[61154,null,"See CPT",2192.0940000000001,2192.0940000000001,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,null,2,29]
[61215,null,"See CPT",886.44899999999996,886.44899999999996,"090",0.11,0.76,0.13,0,2,0,1,1,0,null,"R",null,null,2,29]
[61321,null,"See CPT",3626.277,3626.277,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61345,null,"See CPT",3485.58,3485.58,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61519,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]
[61536,null,"See CPT",4387.6620000000003,4387.6620000000003,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61544,null,"See CPT",3238.9259999999999,3238.9259999999999,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM",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]
[61580,null,"See CPT",4444.9829999999993,4444.9829999999993,"090",0.11,0.76,0.13,0,2,1,1,1,2,null,"R",null,"Y-CM",2,29]
[61584,null,"See CPT",5011.8239999999996,5011.8239999999996,"090",0.11,0.76,0.13,0,2,1,2,1,2,null,"R",null,"Y-CM",2,29]
[61600,null,"See CPT",3794.7660000000001,3794.7660000000001,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM",2,29]
[61613,null,"See CPT",5681.7269999999999,5681.7269999999999,"090",0.11,0.76,0.13,0,2,1,2,1,2,null,"R",null,"Y-CM",2,29]
[61642,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[61698,null,"See CPT",7835.6070000000009,7835.6070000000009,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61720,null,"See CPT",2178.1979999999999,2178.1979999999999,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[61791,null,"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,1,0,0,0,null,"X",null,null,2,29]
[61860,null,"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]
[61868,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,2,1,0,null,"X",null,null,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]
[62147,null,"See CPT",2431.221,2431.221,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[62192,null,"See CPT",1688.943,1688.943,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[62230,null,"See CPT",1448.6579999999999,1448.6579999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[62273,null,"See CPT",303.97499999999997,192.80699999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[62302,null,"See CPT",474.20099999999996,203.80799999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[62323,null,"See CPT",488.67599999999993,171.38399999999999,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62327,null,"See CPT",489.25499999999994,178.33199999999999,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62367,null,"See CPT",56.741999999999997,43.424999999999997,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-UR",2,29]
[63012,null,"See CPT",2051.3969999999999,2051.3969999999999,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63043,null,"See CPT",1245.4226928000003,1245.4226928000003,"000",0,0,0,0,0,1,2,2,0,null,"F",null,"Y-UR",2,29]
[63051,null,"See CPT",2912.37,2912.37,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63086,null,"See CPT",320.76600000000002,320.76600000000002,"000",0,0,0,0,0,0,2,2,2,null,"R",null,"Y-UR",2,29]
[63173,null,"See CPT",2951.163,2951.163,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63185,null,"See CPT",1959.915,1959.915,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63199,null,"See CPT",3732.2339999999995,3732.2339999999995,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63278,null,"See CPT",2730.5639999999999,2730.5639999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63285,null,"See CPT",4452.51,4452.51,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63304,null,"See CPT",4006.6800000000003,4006.6800000000003,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63655,null,"See CPT","Not Covered","Not Covered","090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X",null,"Y-UR",2,29]
[63702,null,"See CPT",2458.4340000000002,2458.4340000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[64408,null,"See CPT",143.01300000000001,77.007000000000005,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[64415,null,"See CPT",203.80799999999999,107.694,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[64435,null,"See CPT",144.75,75.27,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[64462,null,"See CPT",130.85399999999998,83.375999999999991,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64487,null,"See CPT",380.40300000000002,108.85199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64520,null,"See CPT",428.46000000000004,147.066,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64580,null,"See CPT",545.99699999999996,545.99699999999996,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[64611,null,"See CPT",228.126,194.54399999999998,"010",0.1,0.8,0.1,0,2,2,0,0,0,null,"R",null,"Y-CM",2,29]
[64634,null,"See CPT",353.19,116.37899999999999,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR",2,29]
[64645,null,"See CPT",212.49299999999999,140.11799999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64650,null,"See CPT",159.80399999999997,68.900999999999996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[64718,null,"See CPT",1047.99,1047.99,"090",0.11,0.76,0.13,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[64734,null,"See CPT",885.87,885.87,"090",0.11,0.76,0.13,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[64772,null,"See CPT",976.19399999999996,976.19399999999996,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[64784,null,"See CPT",1263.3779999999999,1263.3779999999999,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R",null,null,2,29]
[64821,null,"See CPT",1214.163,1214.163,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64857,null,"See CPT",1818.06,1818.06,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64866,null,"See CPT",2197.884,2197.884,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64874,null,"See CPT",295.86900000000003,295.86900000000003,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[64898,null,"See CPT",2358.846,2358.846,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64912,null,"See CPT",1528.56,1528.56,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[65130,null,"See CPT",1466.607,1466.607,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[65205,null,"See CPT",50.951999999999998,49.214999999999996,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[65285,null,"See CPT",1893.9090000000001,1893.9090000000001,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65600,null,"See CPT",755.59500000000003,584.21100000000001,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65760,null,"See CPT",4133.9967926400004,4133.9967926400004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,29]
[65771,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[65855,null,"See CPT",428.46000000000004,350.29499999999996,"010",0.1,0.8,0.1,0,2,1,1,1,1,null,"R",null,null,2,29]
[65870,null,"See CPT",1025.4090000000001,1025.4090000000001,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66170,null,"See CPT",1880.5919999999999,1880.5919999999999,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[66183,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]
[66682,null,"See CPT",1228.059,1228.059,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[66740,null,"See CPT",763.70099999999991,671.06099999999992,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[66930,null,"See CPT",1466.607,1466.607,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[66984,null,"See CPT",932.19,932.19,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67031,null,"See CPT",680.32499999999993,611.42399999999998,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67042,null,"See CPT",1951.23,1951.23,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67208,null,"See CPT",1037.568,988.35299999999995,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67220,null,"See CPT",922.34699999999998,855.76199999999994,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[67318,null,"See CPT",1229.7959999999998,1229.7959999999998,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[67335,null,"See CPT",245.49600000000001,245.49600000000001,"000",0,0,0,0,0,1,1,1,0,null,"R",null,"Y-CM",2,29]
[67400,null,"See CPT",1789.11,1789.11,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[67440,null,"See CPT",2317.1579999999999,2317.1579999999999,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67808,null,"See CPT",631.68899999999996,631.68899999999996,"090",0.1,0.7,0.2,0,2,0,1,0,0,null,"R",null,null,2,29]
[67835,null,"See CPT",754.4369999999999,754.4369999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[67909,null,"See CPT",975.61500000000001,753.279,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67917,null,"See CPT",1115.154,782.80799999999999,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67950,null,"See CPT",1036.989,793.80900000000008,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[67999,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[68130,null,"See CPT",986.61599999999987,708.11699999999996,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[68371,null,"See CPT",710.43299999999999,710.43299999999999,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[68550,null,"See CPT","Not Covered","Not Covered","090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X",null,null,2,29]
[68750,null,"See CPT",1465.4489999999998,1465.4489999999998,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[69005,null,"See CPT",402.40499999999997,281.39400000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[69120,null,"See CPT",728.38199999999995,728.38199999999995,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[69210,null,"See CPT",83.954999999999998,56.741999999999997,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[69420,null,"See CPT",355.50599999999997,214.809,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69450,null,"See CPT",1020.198,1020.198,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,null,2,29]
[69602,null,"See CPT",1992.9180000000001,1992.9180000000001,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[69633,null,"See CPT",1934.4389999999999,1934.4389999999999,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[69644,null,"See CPT",2761.2509999999997,2761.2509999999997,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69714,null,"See CPT",1911.2789999999998,1911.2789999999998,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69740,null,"See CPT",2097.1379999999999,2097.1379999999999,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R",null,null,2,29]
[69915,null,"See CPT",2701.6139999999996,2701.6139999999996,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[70015,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[70100,26,"See CPT",15.054,15.054,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70130,null,"See CPT",112.905,112.905,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70140,"TC","See CPT",41.108999999999995,41.108999999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70160,26,"See CPT",13.895999999999999,13.895999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70210,26,"See CPT",14.475,14.475,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70240,26,"See CPT",15.633000000000001,15.633000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70300,null,"See CPT",22.581,22.581,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70332,"TC","See CPT",109.431,109.431,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[70350,"TC","See CPT",13.895999999999999,13.895999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70360,null,"See CPT",56.741999999999997,56.741999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70390,26,"See CPT",31.266000000000002,31.266000000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70450,26,"See CPT",70.058999999999997,70.058999999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70481,26,"See CPT",92.061000000000007,92.061000000000007,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70486,26,"See CPT",70.637999999999991,70.637999999999991,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70492,null,"See CPT",435.40799999999996,435.40799999999996,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70496,26,"See CPT",143.59199999999998,143.59199999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70543,26,"See CPT",176.595,176.595,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70545,null,"See CPT",455.09399999999999,455.09399999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70549,26,"See CPT",148.22399999999999,148.22399999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[70551,26,"See CPT",122.16899999999998,122.16899999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70555,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[70558,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[71048,null,"See CPT",81.059999999999988,81.059999999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71100,26,"See CPT",17.948999999999998,17.948999999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71120,26,"See CPT",16.212,16.212,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71250,null,"See CPT",255.91799999999998,255.91799999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[71275,26,"See CPT",149.38200000000001,149.38200000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[71551,"TC","See CPT",631.68899999999996,631.68899999999996,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72040,26,"See CPT",19.106999999999999,19.106999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72050,26,"See CPT",22.581,22.581,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72080,null,"See CPT",61.953000000000003,61.953000000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72081,26,"See CPT",22.001999999999999,22.001999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72083,26,"See CPT",29.529,29.529,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72114,26,"See CPT",25.475999999999999,25.475999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72127,26,"See CPT",104.79900000000001,104.79900000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72129,"TC","See CPT",229.863,229.863,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72133,26,"See CPT",104.79900000000001,104.79900000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72142,26,"See CPT",147.64499999999998,147.64499999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72146,26,"See CPT",122.748,122.748,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72156,26,"See CPT",188.75399999999999,188.75399999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72158,26,"See CPT",188.75399999999999,188.75399999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72191,26,"See CPT",147.64499999999998,147.64499999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72194,null,"See CPT",502.57199999999995,502.57199999999995,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72197,26,"See CPT",180.648,180.648,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[72220,26,"See CPT",14.475,14.475,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72255,26,"See CPT",79.901999999999987,79.901999999999987,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72265,26,"See CPT",68.321999999999989,68.321999999999989,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73010,null,"See CPT",42.266999999999996,42.266999999999996,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73010,26,"See CPT",15.054,15.054,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73050,26,"See CPT",15.633000000000001,15.633000000000001,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[73080,null,"See CPT",57.9,57.9,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73092,26,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[73120,26,"See CPT",13.895999999999999,13.895999999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73140,26,"See CPT",11.58,11.58,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73200,26,"See CPT",82.217999999999989,82.217999999999989,"000",0,0,0,1,9,3,0,0,0,null,"R",null,null,2,26]
[73220,null,"See CPT",847.077,847.077,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73220,26,"See CPT",177.17400000000001,177.17400000000001,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73225,26,"See CPT",142.434,142.434,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[73503,null,"See CPT",105.378,105.378,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73523,26,"See CPT",26.055,26.055,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73552,"TC","See CPT",48.056999999999995,48.056999999999995,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73564,26,"See CPT",19.106999999999999,19.106999999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73565,26,"See CPT",13.895999999999999,13.895999999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[73615,null,"See CPT",248.39099999999999,248.39099999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73615,26,"See CPT",48.056999999999995,48.056999999999995,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73650,26,"See CPT",13.317,13.317,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73706,"TC","See CPT",481.72800000000001,481.72800000000001,"000",0,0,0,1,9,3,0,0,0,null,"R",null,null,2,26]
[73719,26,"See CPT",133.16999999999999,133.16999999999999,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73722,"TC","See CPT",514.15200000000004,514.15200000000004,"000",0,0,0,1,9,3,0,0,0,null,"R",null,"Y-UR",2,26]
[74018,26,"See CPT",15.054,15.054,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74022,26,"See CPT",26.055,26.055,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74160,"TC","See CPT",353.76900000000001,353.76900000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[74174,26,"See CPT",178.911,178.911,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[74177,26,"See CPT",149.96099999999998,149.96099999999998,"000",0,0,0,1,9,0,9,0,0,null,"R",null,null,2,26]
[74182,26,"See CPT",142.434,142.434,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[74210,null,"See CPT",178.33199999999999,178.33199999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74235,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74246,26,"See CPT",73.533000000000001,73.533000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74251,26,"See CPT",96.692999999999998,96.692999999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74262,"TC","See CPT",754.4369999999999,754.4369999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[74270,"TC","See CPT",200.91300000000001,200.91300000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74300,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74328,26,"See CPT",48.635999999999996,48.635999999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",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]
[74410,"TC","See CPT",221.178,221.178,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74420,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74425,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74450,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74470,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[74713,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[74742,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[75561,null,"See CPT",750.38400000000001,750.38400000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75572,"TC","See CPT",350.87399999999997,350.87399999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75600,26,"See CPT",41.108999999999995,41.108999999999995,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75605,26,"See CPT",91.481999999999999,91.481999999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75716,null,"See CPT",302.238,302.238,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[75716,"TC","See CPT",143.01300000000001,143.01300000000001,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[75736,26,"See CPT",89.165999999999997,89.165999999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75746,null,"See CPT",251.28599999999997,251.28599999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75801,26,"See CPT",73.533000000000001,73.533000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75809,26,"See CPT",39.372,39.372,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75820,26,"See CPT",85.691999999999993,85.691999999999993,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75822,26,"See CPT",118.69499999999999,118.69499999999999,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[75842,null,"See CPT",294.13200000000001,294.13200000000001,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[75842,26,"See CPT",123.32699999999998,123.32699999999998,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[75880,26,"See CPT",57.9,57.9,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75889,null,"See CPT",231.6,231.6,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[75894,26,"See CPT",118.69499999999999,118.69499999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75902,"TC","See CPT",135.48599999999999,135.48599999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75958,26,"See CPT",320.18700000000001,320.18700000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75959,26,"See CPT",279.65699999999998,279.65699999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76080,null,"See CPT",107.11500000000001,107.11500000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76080,26,"See CPT",42.845999999999997,42.845999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76101,26,"See CPT",45.161999999999999,45.161999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76125,26,"See CPT",22.581,22.581,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76390,null,"See CPT",773.54399999999998,773.54399999999998,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM",2,26]
[76496,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[76506,null,"See CPT",212.49299999999999,212.49299999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76512,null,"See CPT",85.691999999999993,85.691999999999993,"000",0,0,0,1,9,3,0,0,0,null,"R",null,null,2,26]
[76516,null,"See CPT",82.796999999999997,82.796999999999997,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[76519,null,"See CPT",118.69499999999999,118.69499999999999,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[76604,null,"See CPT",117.53699999999999,117.53699999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[76700,null,"See CPT",219.441,219.441,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[76775,null,"See CPT",103.64100000000001,103.64100000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[76800,26,"See CPT",99.587999999999994,99.587999999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76810,null,"See CPT",164.43599999999998,164.43599999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76813,null,"See CPT",222.91499999999999,222.91499999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76816,null,"See CPT",207.86099999999999,207.86099999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76817,null,"See CPT",174.279,174.279,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76820,null,"See CPT",84.533999999999992,84.533999999999992,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76826,null,"See CPT",305.13299999999998,305.13299999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76830,"TC","See CPT",169.06799999999998,169.06799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76857,null,"See CPT",86.271000000000001,86.271000000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[76881,null,"See CPT",116.37899999999999,116.37899999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76886,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76937,null,"See CPT",68.900999999999996,68.900999999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76937,26,"See CPT",23.16,23.16,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76948,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76965,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76978,"TC","See CPT",438.88200000000001,438.88200000000001,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76982,null,"See CPT",178.911,178.911,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[76999,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77001,26,"See CPT",30.108000000000001,30.108000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77014,null,"See CPT",220.01999999999998,220.01999999999998,"000",0,0,0,1,0,0,9,0,0,null,"R",null,"Y-CM",2,26]
[77014,26,"See CPT",75.27,75.27,"000",0,0,0,1,0,0,9,0,0,null,"R",null,"Y-CM",2,26]
[77049,null,"See CPT",697.69500000000005,697.69500000000005,"000",0,0,0,1,9,2,0,0,0,null,"R",null,"Y-UR",2,26]
[77053,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,9,0,0,null,"X",null,null,2,26]
[77062,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,9,0,0,null,"X",null,null,2,26]
[77066,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,2,0,0,0,null,"N",null,"Y-CM",2,26]
[77073,"TC","See CPT",57.9,57.9,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77075,26,"See CPT",45.741,45.741,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77080,26,"See CPT",16.212,16.212,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77081,"TC","See CPT",40.529999999999994,40.529999999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77280,26,"See CPT",63.690000000000005,63.690000000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77285,26,"See CPT",96.11399999999999,96.11399999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77299,26,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77301,26,"See CPT",709.27499999999998,709.27499999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77317,"TC","See CPT",383.87700000000001,383.87700000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77321,"TC","See CPT",81.059999999999988,81.059999999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77334,26,"See CPT",101.904,101.904,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77338,null,"See CPT",835.49699999999996,835.49699999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",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]
[77499,26,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77600,26,"See CPT",118.69499999999999,118.69499999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77620,null,"See CPT",1184.0549999999998,1184.0549999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77761,"TC","See CPT",380.98199999999997,380.98199999999997,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77768,"TC","See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,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]
[77778,null,"See CPT",1559.2469999999998,1559.2469999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77799,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78013,"TC","See CPT",330.60899999999998,330.60899999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78018,26,"See CPT",67.742999999999995,67.742999999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78072,null,"See CPT",809.44200000000001,809.44200000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78102,null,"See CPT",313.81799999999998,313.81799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78110,null,"See CPT",127.95899999999999,127.95899999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78111,null,"See CPT",136.64399999999998,136.64399999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78122,null,"See CPT",177.17400000000001,177.17400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78185,null,"See CPT",314.976,314.976,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78199,26,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78215,null,"See CPT",357.24299999999999,357.24299999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78230,null,"See CPT",319.60799999999995,319.60799999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78258,null,"See CPT",389.66700000000003,389.66700000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78264,null,"See CPT",606.79200000000003,606.79200000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78264,26,"See CPT",63.690000000000005,63.690000000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78290,"TC","See CPT",549.471,549.471,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78291,"TC","See CPT",387.351,387.351,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78305,26,"See CPT",67.742999999999995,67.742999999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78350,"TC","See CPT",38.792999999999999,38.792999999999999,"000",0,0,0,1,9,9,9,9,9,null,"R",null,null,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]
[78432,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR",2,26]
[78445,null,"See CPT",377.50799999999998,377.50799999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78445,26,"See CPT",42.266999999999996,42.266999999999996,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78457,null,"See CPT",330.60899999999998,330.60899999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78458,null,"See CPT",372.29699999999997,372.29699999999997,"000",0,0,0,1,9,2,0,0,0,null,"R",null,"Y-CM",2,26]
[78468,"TC","See CPT",299.92199999999997,299.92199999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78473,null,"See CPT",530.94299999999998,530.94299999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78491,26,"See CPT",121.59,121.59,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78496,null,"See CPT",77.007000000000005,77.007000000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78582,null,"See CPT",607.37099999999998,607.37099999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78582,26,"See CPT",86.271000000000001,86.271000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78605,null,"See CPT",364.19099999999997,364.19099999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78606,null,"See CPT",607.37099999999998,607.37099999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78609,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,9,9,9,9,9,null,"N",null,"Y-CM",2,26]
[78645,null,"See CPT",593.47500000000002,593.47500000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78699,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78707,null,"See CPT",420.93299999999999,420.93299999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78730,null,"See CPT",143.59199999999998,143.59199999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78761,null,"See CPT",385.03500000000003,385.03500000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78802,null,"See CPT",571.47299999999996,571.47299999999996,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78803,null,"See CPT",707.53800000000001,707.53800000000001,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78808,null,"See CPT",73.533000000000001,73.533000000000001,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78815,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",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",37.055999999999997,37.055999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79200,"TC","See CPT",100.167,100.167,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79403,"TC","See CPT",149.96099999999998,149.96099999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[79445,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[80074,null,"See CPT",67.63,67.63,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80143,null,"See CPT",26.468799999999998,26.468799999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80165,null,"See CPT",19.226799999999997,19.226799999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80171,null,"See CPT",30.7714,30.7714,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80186,null,"See CPT",19.539199999999997,19.539199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80200,null,"See CPT",22.904599999999999,22.904599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80230,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",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]
[80331,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80334,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80347,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80352,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80366,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]
[80410,null,"See CPT",114.1254,114.1254,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80417,null,"See CPT",62.465800000000002,62.465800000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80439,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81003,null,"See CPT",3.1949999999999998,3.1949999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81105,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81112,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81173,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]
[81205,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81215,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81221,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81229,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81240,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81247,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81254,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81261,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81277,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81283,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]
[81312,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81319,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81326,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81333,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81350,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81353,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81363,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81400,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81407,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81415,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81433,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81439,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81479,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81500,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]
[81529,null,"See CPT",10214.06,10214.06,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC",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]
[82013,null,"See CPT",17.451799999999999,17.451799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82085,null,"See CPT",13.7882,13.7882,"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]
[82131,null,"See CPT",32.631599999999999,32.631599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82175,null,"See CPT",26.937399999999997,26.937399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82232,null,"See CPT",22.9756,22.9756,"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]
[82340,null,"See CPT",8.5625999999999998,8.5625999999999998,"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]
[82415,null,"See CPT",17.991399999999999,17.991399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82525,null,"See CPT",17.622199999999999,17.622199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82542,null,"See CPT",34.207799999999999,34.207799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82610,null,"See CPT",26.298399999999997,26.298399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82638,null,"See CPT",17.395,17.395,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,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]
[82696,null,"See CPT",37.260799999999996,37.260799999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82775,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82785,null,"See CPT",23.373200000000001,23.373200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82946,null,"See CPT",25.2334,25.2334,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82952,null,"See CPT",5.5663999999999998,5.5663999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83006,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83015,null,"See CPT",29.7348,29.7348,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83051,null,"See CPT",10.380199999999999,10.380199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83068,null,"See CPT",13.4474,13.4474,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83519,null,"See CPT",26.127999999999997,26.127999999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83528,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]
[83664,null,"See CPT",27.4344,27.4344,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[83727,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83835,null,"See CPT",24.0548,24.0548,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83916,null,"See CPT",38.893799999999999,38.893799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83945,null,"See CPT",20.518999999999998,20.518999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84075,null,"See CPT",7.355599999999999,7.355599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84081,null,"See CPT",23.458399999999997,23.458399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84112,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84144,null,"See CPT",29.621199999999998,29.621199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84156,null,"See CPT",5.2113999999999994,5.2113999999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84182,null,"See CPT",41.478200000000001,41.478200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84238,null,"See CPT",51.929400000000001,51.929400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84285,null,"See CPT",35.798200000000001,35.798200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84378,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84431,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84443,null,"See CPT",23.855999999999998,23.855999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84478,null,"See CPT",8.1508000000000003,8.1508000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84490,null,"See CPT",14.100599999999998,14.100599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84578,null,"See CPT",6.3473999999999995,6.3473999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84600,null,"See CPT",24.296199999999999,24.296199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84703,null,"See CPT",10.678399999999998,10.678399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85044,null,"See CPT",6.1201999999999988,6.1201999999999988,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85130,null,"See CPT",16.883800000000001,16.883800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85240,null,"See CPT",25.417999999999996,25.417999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85270,null,"See CPT",25.417999999999996,25.417999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85302,null,"See CPT",17.054199999999998,17.054199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85360,null,"See CPT",11.9422,11.9422,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85390,26,"See CPT",63.111000000000004,63.111000000000004,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[85410,null,"See CPT",10.9482,10.9482,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85555,null,"See CPT",10.607399999999998,10.607399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85612,null,"See CPT",24.835799999999995,24.835799999999995,"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]
[85810,null,"See CPT",16.571400000000001,16.571400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86063,null,"See CPT",8.1933999999999987,8.1933999999999987,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86147,null,"See CPT",36.138999999999996,36.138999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86162,null,"See CPT",28.854399999999998,28.854399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86226,null,"See CPT",17.196199999999997,17.196199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86309,null,"See CPT",9.1873999999999985,9.1873999999999985,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86318,null,"See CPT",25.687799999999999,25.687799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86328,null,"See CPT",20.321215200000005,20.321215200000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,23]
[86340,null,"See CPT",21.413599999999999,21.413599999999999,"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]
[86408,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,23]
[86590,null,"See CPT",17.9772,17.9772,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86602,null,"See CPT",14.455599999999999,14.455599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86632,null,"See CPT",18.005599999999998,18.005599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86644,null,"See CPT",20.433800000000002,20.433800000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86658,null,"See CPT",18.502599999999997,18.502599999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86687,null,"See CPT",12.9078,12.9078,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86705,null,"See CPT",16.7134,16.7134,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86711,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[86750,null,"See CPT",18.729799999999997,18.729799999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86768,null,"See CPT",18.729799999999997,18.729799999999997,"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]
[86800,null,"See CPT",22.592199999999998,22.592199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86812,null,"See CPT",36.650199999999998,36.650199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86832,null,"See CPT",459.72499999999997,459.72499999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86891,null,"See CPT"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[86906,null,"See CPT",11.004999999999999,11.004999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86941,null,"See CPT",17.196199999999997,17.196199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86972,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]
[87143,null,"See CPT",17.778399999999998,17.778399999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87164,null,"See CPT",15.2508,15.2508,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87186,null,"See CPT",12.282999999999999,12.282999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87230,null,"See CPT",28.030799999999996,28.030799999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87265,null,"See CPT",17.011600000000001,17.011600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87279,null,"See CPT",23.330599999999997,23.330599999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87301,null,"See CPT",17.011600000000001,17.011600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87305,null,"See CPT",17.011600000000001,17.011600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87340,null,"See CPT",14.6686,14.6686,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87400,null,"See CPT",20.064599999999999,20.064599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87472,null,"See CPT",60.832799999999999,60.832799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87487,null,"See CPT",60.832799999999999,60.832799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,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]
[87530,null,"See CPT",60.832799999999999,60.832799999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87531,null,"See CPT",82.36,82.36,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87541,null,"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87560,null,"See CPT",38.751799999999996,38.751799999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87625,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[87641,null,"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87798,null,"See CPT",49.827800000000003,49.827800000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87809,null,"See CPT",30.8992,30.8992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87902,null,"See CPT",365.57899999999995,365.57899999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87905,null,"See CPT",17.352399999999999,17.352399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[88016,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[88040,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[88112,null,"See CPT",118.116,118.116,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88125,null,"See CPT",46.32,46.32,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88148,null,"See CPT",22.72,22.72,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88161,26,"See CPT",43.424999999999997,43.424999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88172,null,"See CPT",95.534999999999997,95.534999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88173,null,"See CPT",272.709,272.709,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88182,26,"See CPT",64.847999999999999,64.847999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88199,"TC","See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,23]
[88261,null,"See CPT",375.36279999999994,375.36279999999994,"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]
[88300,26,"See CPT",7.5270000000000001,7.5270000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88307,null,"See CPT",510.678,510.678,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88311,"TC","See CPT",15.633000000000001,15.633000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88312,26,"See CPT",45.161999999999999,45.161999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88323,null,"See CPT",195.702,195.702,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88331,"TC","See CPT",75.849000000000004,75.849000000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88341,"TC","See CPT",118.116,118.116,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88344,26,"See CPT",64.269000000000005,64.269000000000005,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88356,26,"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",391.98299999999995,391.98299999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88365,null,"See CPT",328.87199999999996,328.87199999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88366,null,"See CPT",520.52099999999996,520.52099999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88369,26,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88374,null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88381,null,"See CPT",365.34899999999999,365.34899999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88388,26,"See CPT",40.529999999999994,40.529999999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[89051,null,"See CPT",7.9519999999999991,7.9519999999999991,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[89251,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89261,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89264,null,"See CPT"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[89335,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89344,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[90287,null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,16]
[90377,null,"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90472,null,"See CPT",23.738999999999997,23.738999999999997,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,16]
[90632,null,"See CPT",58.76,58.76,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90650,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90651,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90673,null,"See CPT",3.96,3.96,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90680,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90696,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90716,null,"See CPT",174.97,174.97,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90740,null,"See CPT",140.76,140.76,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90833,null,"See CPT",121.59,107.694,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM",2,17]
[90846,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,17]
[90847,null,"See CPT",171.96299999999999,170.80500000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,17]
[90876,null,"See CPT",182.38499999999999,163.27799999999999,"000",0,0,0,9,9,9,9,9,9,null,"R",null,"Y-CM",2,17]
[90912,null,"See CPT",146.48699999999999,74.691000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,17,6]
[90956,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[90965,null,"See CPT",867.34199999999998,867.34199999999998,"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]
[91022,null,"See CPT",313.81799999999998,313.81799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91034,26,"See CPT",84.533999999999992,84.533999999999992,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91035,26,"See CPT",138.95999999999998,138.95999999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91065,null,"See CPT",168.489,168.489,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91111,26,"See CPT",87.429000000000002,87.429000000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91132,26,"See CPT",45.161999999999999,45.161999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91299,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2]
[92015,null,"See CPT",34.160999999999994,33.002999999999993,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2]
[92065,null,"See CPT",94.955999999999989,94.955999999999989,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM",2]
[92082,null,"See CPT",83.954999999999998,83.954999999999998,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2]
[92083,null,"See CPT",111.747,111.747,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2]
[92136,26,"See CPT",51.530999999999999,51.530999999999999,"000",0,0,0,1,9,3,0,0,0,null,"R",null,null,2]
[92145,"TC","See CPT",12.738,12.738,"000",0,0,0,1,9,2,0,0,0,null,"R",null,"Y-CM",2]
[92235,26,"See CPT",71.795999999999992,71.795999999999992,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[92250,null,"See CPT",68.321999999999989,68.321999999999989,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[92283,null,"See CPT",97.850999999999999,97.850999999999999,"000",0,0,0,1,9,2,0,0,0,null,"R",null,"Y-CM",2,26]
[92286,26,"See CPT",36.476999999999997,36.476999999999997,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[92315,null,"See CPT",149.38200000000001,35.897999999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92325,null,"See CPT",85.691999999999993,85.691999999999993,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[92502,null,"See CPT",163.857,163.857,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92508,null,"See CPT",41.108999999999995,41.108999999999995,"000",0,0,0,9,9,0,0,0,0,null,"R",null,null,2]
[92524,null,"See CPT",190.49099999999999,190.49099999999999,"000",0,0,0,9,9,0,0,0,0,null,"R",null,null,2]
[92537,26,"See CPT",53.847000000000001,53.847000000000001,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[92542,26,"See CPT",43.424999999999997,43.424999999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92545,26,"See CPT",23.16,23.16,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92550,null,"See CPT",39.372,39.372,"000",0,0,0,9,0,2,0,0,0,null,"R",null,null,2,5]
[92553,null,"See CPT",72.953999999999994,72.953999999999994,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2,5]
[92571,null,"See CPT",50.372999999999998,50.372999999999998,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2,5]
[92577,null,"See CPT",28.95,28.95,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2,5]
[92593,null,"See CPT"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,5]
[92596,null,"See CPT",121.59,121.59,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2,5]
[92611,null,"See CPT",160.96199999999999,160.96199999999999,"000",0,0,0,9,0,0,0,0,0,null,"R",null,"Y-CM",2,5]
[92617,null,"See CPT","Bundled","Bundled","000",0,0,0,0,0,0,0,0,0,null,"B",null,"Y-CM",2,5]
[92653,null,"See CPT",153.435,153.435,"000",0,0,0,0,0,2,0,0,0,null,"R",null,"Y-CM",2,5]
[92925,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[92960,null,"See CPT",280.815,186.43800000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[92973,null,"See CPT",300.50100000000003,300.50100000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[92998,null,"See CPT",536.154,536.154,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[93016,null,"See CPT",37.055999999999997,37.055999999999997,"000",0,0,0,2,0,0,0,0,0,null,"R",null,null,2,26]
[93040,null,"See CPT",23.16,23.16,"000",0,0,0,4,9,0,0,0,0,null,"R",null,null,2,26]
[93227,null,"See CPT",32.423999999999999,32.423999999999999,"000",0,0,0,2,0,0,0,0,0,null,"R",null,null,2,26]
[93260,"TC","See CPT",61.953000000000003,61.953000000000003,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93268,null,"See CPT",363.61200000000002,363.61200000000002,"000",0,0,0,4,9,0,0,0,0,null,"R",null,null,2,26]
[93278,26,"See CPT",21.422999999999998,21.422999999999998,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93281,26,"See CPT",72.375,72.375,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93286,26,"See CPT",26.055,26.055,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93288,"TC","See CPT",63.690000000000005,63.690000000000005,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93291,"TC","See CPT",56.162999999999997,56.162999999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93293,26,"See CPT",25.475999999999999,25.475999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93306,"TC","See CPT",251.28599999999997,251.28599999999997,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93308,null,"See CPT",184.70099999999999,184.70099999999999,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93313,null,"See CPT",19.106999999999999,19.106999999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[93317,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93350,"TC","See CPT",231.02100000000002,231.02100000000002,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93352,null,"See CPT",61.953000000000003,61.953000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[93451,"TC","See CPT",1470.0809999999999,1470.0809999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93456,"TC","See CPT",1681.4159999999999,1681.4159999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93459,null,"See CPT",2200.779,2200.779,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93461,"TC","See CPT",2005.077,2005.077,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93464,26,"See CPT",150.54,150.54,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93531,26,"See CPT","Not Covered","Not Covered","000",0,0,0,1,2,0,0,0,0,null,"X",null,null,2,26]
[93561,26,"See CPT",77.585999999999999,77.585999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[93566,null,"See CPT",258.81299999999999,77.585999999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[93572,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93603,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93610,26,"See CPT",280.815,280.815,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93612,26,"See CPT",278.49899999999997,278.49899999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93620,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93622,26,"See CPT",292.97399999999999,292.97399999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93631,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,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93656,null,"See CPT",1912.4370000000001,1912.4370000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-UR",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]
[93750,null,"See CPT",86.271000000000001,67.163999999999987,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93786,null,"See CPT",42.845999999999997,42.845999999999997,"000",0,0,0,3,9,0,0,0,0,null,"R",null,null,2,26]
[93882,26,"See CPT",42.266999999999996,42.266999999999996,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93888,null,"See CPT",308.02800000000002,308.02800000000002,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93895,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,9,0,0,0,0,null,"N",null,null,2,26]
[93922,26,"See CPT",20.843999999999998,20.843999999999998,"000",0,0,0,1,9,2,0,0,0,null,"R",null,null,2,26]
[93926,26,"See CPT",39.372,39.372,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93931,26,"See CPT",40.529999999999994,40.529999999999994,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93976,26,"See CPT",65.426999999999992,65.426999999999992,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93978,26,"See CPT",65.426999999999992,65.426999999999992,"000",0,0,0,1,9,0,0,0,0,null,"R",null,null,2,26]
[93986,26,"See CPT",41.108999999999995,41.108999999999995,"000",0,0,0,1,9,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93998,null,"See CPT"," By Report "," By Report ","000",0,0,0,0,0,0,0,1,1,null,"N",null,null,2,26]
[94060,null,"See CPT",81.638999999999996,81.638999999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94070,null,"See CPT",111.16799999999999,111.16799999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94450,null,"See CPT",112.32599999999999,112.32599999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94453,null,"See CPT",128.53800000000001,128.53800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94645,null,"See CPT",31.266000000000002,31.266000000000002,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,26]
[94668,null,"See CPT",61.953000000000003,61.953000000000003,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,26]
[94726,"TC","See CPT",78.744,78.744,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94727,26,"See CPT",20.843999999999998,20.843999999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94775,null,"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2,26]
[94799,null,"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[95012,null,"See CPT",37.055999999999997,37.055999999999997,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[95076,null,"See CPT",214.809,129.696,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[95146,null,"See CPT",121.011,5.2109999999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95170,null,"See CPT",22.001999999999999,5.2109999999999994,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95700,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,null,"See CPT",305.13299999999998,305.13299999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95801,"TC","See CPT",90.323999999999998,90.323999999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95808,"TC","See CPT",1078.098,1078.098,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95810,"TC","See CPT",923.50499999999988,923.50499999999988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95816,"TC","See CPT",607.37099999999998,607.37099999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95822,"TC","See CPT",673.37700000000007,673.37700000000007,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95857,null,"See CPT",99.009,50.372999999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[95863,null,"See CPT",408.19499999999999,408.19499999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95866,26,"See CPT",112.905,112.905,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95867,26,"See CPT",72.375,72.375,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95873,26,"See CPT",33.581999999999994,33.581999999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95874,26,"See CPT",33.581999999999994,33.581999999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95887,26,"See CPT",64.269000000000005,64.269000000000005,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95907,"TC","See CPT",78.165000000000006,78.165000000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95911,"TC","See CPT",174.858,174.858,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95921,null,"See CPT",160.38300000000001,160.38300000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95924,"TC","See CPT",122.16899999999998,122.16899999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95925,26,"See CPT",48.056999999999995,48.056999999999995,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95930,26,"See CPT",31.266000000000002,31.266000000000002,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95933,26,"See CPT",54.425999999999995,54.425999999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95939,"TC","See CPT",808.28399999999999,808.28399999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95955,null,"See CPT",400.66800000000001,400.66800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95962,null,"See CPT",471.30600000000004,471.30600000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95966,"TC","See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95980,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[95999,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
[96020,null,"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,17]
[96113,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[96133,null,"See CPT",178.33199999999999,134.32799999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[96161,null,"See CPT","Not Covered","Not Covered","000",0,0,0,5,9,9,9,9,9,null,"X",null,null,2,22]
[96365,null,"See CPT",136.065,136.065,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[96401,null,"See CPT",152.27699999999999,152.27699999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[96415,null,"See CPT",57.320999999999998,57.320999999999998,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[96446,null,"See CPT",397.77300000000002,43.424999999999997,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2]
[96549,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
[96921,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
[96934,null,"See CPT",75.27,75.27,"000",0,0,0,4,0,0,0,0,0,null,"R",null,null,2]
[97016,null,"See CPT",20.843999999999998,20.843999999999998,"000",0,0,0,9,9,0,0,0,0,null,"R",null,null,2,25]
[97035,null,"See CPT",24.896999999999998,24.896999999999998,"000",0,0,0,9,9,0,0,0,0,null,"R",null,null,2,25]
[97152,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,17]
[97157,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,17]
[97163,null,"See CPT",136.74,136.74,"000",0,0,0,9,9,0,0,0,0,null,"F",null,null,2,25]
[97546,null,"See CPT",80.476212959999998,80.476212959999998,"000",0,0,0,9,0,0,0,0,0,null,"F",null,"Y-CM",2,25]
[97750,null,"See CPT",59.058,59.058,"000",0,0,0,9,9,0,0,0,0,null,"R",null,null,2,25]
[97799,null,"See CPT","By Report","By Report","000",0,0,0,9,0,0,0,0,0,null,"N",null,null,2,25]
[97813,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,19]
[98961,null,"See CPT",24.317999999999998,24.317999999999998,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2]
[99026,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[99056,null,"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-CM",2,23]
[99071,null,"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,23]
[99157,null,"See CPT",107.11500000000001,107.11500000000001,"000",0,0,0,9,9,9,9,9,9,null,"R",null,"Y-CM",2,4]
[99188,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99199,null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
[99212,null,"See CPT",99.587999999999994,61.953000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99225,null,"See CPT",121.59,121.59,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99236,null,"See CPT",362.45399999999995,362.45399999999995,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99253,null,"See CPT",193.386,193.386,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99282,null,"See CPT",71.795999999999992,71.795999999999992,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99316,null,"See CPT",177.75299999999999,177.75299999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99325,null,"See CPT",133.16999999999999,133.16999999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99343,null,"See CPT",213.65099999999998,213.65099999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99350,null,"See CPT",304.55399999999997,304.55399999999997,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99375,null,"See CPT",177.17400000000001,148.22399999999999,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99383,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99397,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99403,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99439,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99443,null,"See CPT",226.96799999999999,170.226,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99453,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99464,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99477,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99486,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99498,null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99506,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[99606,null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0001F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0010U",null,"See CPT",606.70920000000001,606.70920000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
["0015F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0021A",null,"See CPT",40,40,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0054T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
["0083U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0092U",null,"See CPT",3532.96,3532.96,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
["0100T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0101U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0107U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0114U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0123U",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]
["0144U",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]
["0160U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0191T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0206U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,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]
["0212U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0217T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,1,0,0,0,null,"N",null,"Y-UR",2]
["0222T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-UR",2]
["0229U",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0237T",null,"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2]
["0264T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0273T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0275T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0316T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0335T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0352T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0375R",null,"Retraining, relocation costs","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,30]
["0392R",null,"Mileage, non-vrc, per mile","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2,30]
["0395R",null,"Dept of personnel rtrn to wrk srvcs","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["0409T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0411A",null,"Claimant - time lost from work to attend department or self-insurer requested ime","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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]
["0424T",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]
["0441A",null,"Wt loss prog,weekly fee,worker reimburse",34.960891680000003,34.960891680000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,21]
["0451T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0454T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0475T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0477T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0485T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,1,9,1,9,9,9,null,"X",null,null,2]
["0497T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,3,9,9,9,9,9,null,"X",null,null,2]
["0504T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,2,9,9,9,9,9,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]
["0518T",null,"See CPT","By Report","By Report","000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-CM",2]
["0520F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0525T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0532T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0538T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0548T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0556F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0562T",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]
["0576T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0580F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0585T",null,"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0620T",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]
["0801V",null,"Early intervention services - intern",8.4330417600000001,8.4330417600000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,30]
["0813V",null,"Assessment services exception- intern",8.4330417600000001,8.4330417600000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,30]
["0844V",null,"Resume services - vrc",9.8928086400000019,9.8928086400000019,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,30]
["0897V",null,"Hotel charges (voc) [out-of-state only]"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,30]
["1007F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1011F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1028M",null,"Review of job offer/analysis by a/p",42.081193440000007,42.081193440000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["1038M",null,"Revw job offer/analysis for empl,per job",56.09075472,56.09075472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["1055F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1066F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1075M",null,"Functional Recovery Intervention Form","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1100F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1112M",null,"Ime-additional examiner",616.7296,616.7296,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1118M",null,"Ime-by psychiatrist",1117.8224,1117.8224,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1125F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1130M",null,"Ime - terminated examination",400.97380752000004,400.97380752000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1137M",null,"IME, Three claims included in evaluation",228.08069856000003,228.08069856000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1152M",null,"Coord of hlth svcs, pt present, initial","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1160M",null,"PGAP Educational Materials",106.06939200000001,106.06939200000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,22]
["1192M",null,"Impairment rating by a/p, complex",770.91200000000003,770.91200000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,12]
["1220M",null,"Nurse case mgmt phone call per unit",10.995510240000002,10.995510240000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,20]
["1222M",null,"Nurse case mgmt case planning per unit",10.995510240000002,10.995510240000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,20]
["1243M",null,"Ur contract:  retrospective inpatient review without bill audit","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1286M",null,"Catastrophic case mgmt Life care planning per 6 minute unit","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1400W",null,"ACTIVITY COACHING INITIAL ASSESSMENT",43.509454560000002,43.509454560000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,22]
["1491F",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",52.3566,49.633199999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",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]
["2023F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2030F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2131A",null,"Naturopathic initial visit, extended",191.87007840000001,191.87007840000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,19]
["3011F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3027F",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]
["3074F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3092F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3096F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3132F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3160F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3267F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3280F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3292F",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]
["3331F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3342F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3376F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3388F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3490F",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]
["3551F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3756F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3761F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4005F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4015F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4043F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4048F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4065F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4084F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4120F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4133F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4155F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4165F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4176F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4185F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4210F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4255F",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]
["4270F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4350F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4510F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4553F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4570A",null,"Claimant - misc. Medical supplies (must specify)","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["5062F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["6020F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["6040F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["6150F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["8894H",null,"L&I Residential facility, mid level care",219.20657616000003,219.20657616000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,36]
["8916H",null,"Home modification evaluation and consultation","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,18]
["9001F",null,"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["9973M",null,"INTERPRETER SCHEDULING ADMIN FEE",7.5,7.5,"000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2,14]
["9982M",null,"OVER PHONE INTERPRETING TIER 3","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2,14]
["A0110",null,"Nonemergency transport bus","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["A0190",null,"Noner transport meals recip","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["A0390",null,"Advanced life support mileag","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,3]
["A0429",null,"Bls-emergency",631.81039472179214,631.81039472179214,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,3]
["A0435",null,"Fixed wing air mileage",35.877865774608004,35.877865774608004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,3]
["A4213",null,"20+ cc syringe only","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4226",null,"Weekly supply maint cgs pump","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A4236",null,"Silvr oxide batt glucose mon",3.24,3.24,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4247",null,"Betadine/iodine swabs/wipes","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4265",null,"Paraffin","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,"Y-CM",2,28,9]
["A4268",null,"Female condom","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A4301",null,"Implantable access syst perc","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4313",null,"Catheter w/bag 3-way","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4333",null,"Urinary cath anchor device","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4338",null,"Indwelling catheter latex","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4358",null,"Urinary leg or abdomen bag","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4363",null,"Ostomy clamp, replacement","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4380",null,"Urinary rubber pouch w fcplt","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4385",null,"Ost skn barrier sld ext wear","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4399",null,"Ostomy irrig cone/cath w brs","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4404",null,"Ostomy ring each","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4417",null,"Ost pch w bar/bltinconv/fltr","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4422",null,"Ost pouch absorbent material","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4450",null,"Non-waterproof tape","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4458",null,"Reusable enema bag","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4500",null,"Below knee surgical stocking",34.76,34.76,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4554",null,"Disposable underpads","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4580",null,"Cast supplies (plaster)","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A4600",null,"Sleeve, inter limb comp dev",22.84,22.84,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4617",null,"Mouth piece",3.6821999999999999,3.6821999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4624",null,"Tracheal suction tube",3.44,3.44,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4640",null,"Alternating pressure pad",90.237914879999991,90.237914879999991,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4649",null,"Surgical supplies","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A4674",null,"Chem/antisept solution, 8oz",109.23,109.23,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["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,2,28,9]
["A4736",null,"Topical anesthetic, per gram","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["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,2,28,9]
["A4913",null,"Misc dialysis supplies noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A4928",null,"Surgical mask",3.02,3.02,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A5063",null,"Drain ostomy pouch w/flange","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A5081",null,"Stoma plug or seal, any type","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A5113",null,"Latex leg strap","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A5504",null,"Diabetic shoe with wedge",37.7502,37.7502,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,28,9]
["A6021",null,"Collagen dressing <=16 sq in","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6196",null,"Alginate dressing <=16 sq in","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6211",null,"Foam drg > 48 sq in w/o brdr","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6218",null,"Non-sterile gauze > 48 sq in","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6228",null,"Gauze <= 16 sq in water/sal","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6235",null,"Hydrocolld drg >16<=48 w/o b","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6242",null,"Hydrogel drg <=16 in w/o bdr","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6254",null,"Absorpt drg <=16 sq in w/bdr","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6262",null,"Wound filler dry form / gram","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6410",null,"Sterile eye pad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6453",null,"Self-adher band w <3\"/yd","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28,9]
["A6501",null,"Compres burngarment bodysuit","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A6503",null,"Compres burngarment facehood","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A6512",null,"Compres burn garment, noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A6544",null,"Gc stocking garter belt",107.25,107.25,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7003",null,"Nebulizer administration set",2.46,2.46,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7012",null,"Nebulizer water collec devic",4.97,4.97,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7018",null,"Water distilled w/nebulizer",0.40800000000000003,0.40800000000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7039",null,"Filter, non disposable w pap",14.16,14.16,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7048",null,"Vacuum drain bottle/tube kit",49.041600000000003,49.041600000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7502",null,"Replacement diaphragm/fplate",59.282399999999996,59.282399999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7521",null,"Trach/laryn tube cuffed",55.855199999999996,55.855199999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A9153",null,"Multi-vitamin nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A9275",null,"Disp home glucose monitor",24.83,24.83,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28,9]
["A9283",null,"Foot press off load supp dev",27.07,27.07,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A9505",null,"Tl201 thallium",173.75,173.75,"000",0,0,0,0,0,0,0,0,0,null,"D",null,"Y-PHL",2,28,9]
["A9517",null,"I131 iodide cap, rx",166.39,166.39,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,28,9]
["A9527",null,"Iodine i-125 sodium iodide",113.86,113.86,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,28,9]
["A9537",null,"Tc99m mebrofenin",63.06,63.06,"000",0,0,0,0,0,0,0,0,0,null,"D",null,"Y-PHL",2,28,9]
["A9548",null,"In111 pentetate",471.04,471.04,"000",0,0,0,0,0,0,0,0,0,null,"D",null,"Y-PHL",2,28,9]
["A9563",null,"P32 na phosphate",347.56,347.56,"000",0,0,0,0,0,0,0,0,0,null,"D",null,null,2,28,9]
["A9569",null,"Technetium tc-99m auto wbc",4212.7700000000004,4212.7700000000004,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,28,9]
["A9584",null,"Iodine i-123 ioflupane",2813.52,2813.52,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,28,9]
["A9591",null,"Fluoroestradiol f 18",11.23,11.23,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,28,9]
["A9606",null,"Radium ra223 dichloride ther","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A9901",null,"Delivery/set up/dispensing",194.2,194.2,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["B4105",null,"Enzyme cartridge enteral nut",180.42,180.42,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["B4153",null,"Ef hydrolyzed/amino acids",1.734,1.734,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["B4176",null,"Parenteral sol amino acid 7-",59.119199999999999,59.119199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["B4189",null,"Parenteral sol amino acid &",219.16740000000001,219.16740000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["B9004","NU","Parenteral infus pump portab",3110.9897999999998,3110.9897999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["C1052",null,"Hemostatic agent, gi, topic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["C1726",null,"Cath, bal dil, non-vascular","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1729",null,"Cath, drainage","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1756",null,"Cath, pacing, transesoph","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1760",null,"Closure dev, vasc","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1767",null,"Generator, neuro non-recharg","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1780",null,"Lens, intraocular (new tech)","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1815",null,"Pros, urinary sph, imp","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1821",null,"Interspinous implant","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C1876",null,"Stent, non-coa/non-cov w/del","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1880",null,"Vena cava filter","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1895",null,"Lead, aicd, endo dual coil","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1899",null,"Lead, pmkr/aicd combination","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C2616",null,"Brachytx, non-str,yttrium-90","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C2627",null,"Cath, suprapubic/cystoscopic","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C2641",null,"Brachytx, non-stranded,p-103","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C2699",null,"Brachytx, non-stranded, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C8903",null,"Mri w/cont, breast,  uni","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C8912",null,"Mra w/cont, lwr ext","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C8914",null,"Mra w/o fol w/cont, lwr ext","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C8929",null,"Tte w or wo fol wcon,doppler","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C8936",null,"Mra, w/o&w/dye, upper extr","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C9057",null,"Inj cetirizine hydrochloride","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["C9077",null,"Inj cabotegravir/rilpivirine",267.3,267.3,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["C9257",null,"Bevacizumab injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C9361",null,"Neuromend nerve wrap","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C9460",null,"Injection, cangrelor","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["C9469",null,"Inj triamcinolone acetonide",0.05,0.05,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,35]
["C9603",null,"Perc d-e cor stent ather br","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C9728",null,"Place device/marker, non pro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C9757",null,"Spine/lumbar disk surgery","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2,35]
["C9765",null,"Revasc intra lithotrip-stent","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2,35]
["C9775",null,"Revasc lith-sten-ath tib/per","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["D0150",null,"Comprehensve oral evaluation",90.085469760000009,90.085469760000009,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D0230",null,"Intraoral periapical ea add",25.866228960000001,25.866228960000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0251",null,"Extraoral posterior image"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D0322",null,"Dental tomographic survey",495.02900304000002,495.02900304000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0368",null,"Cone beam ct interprete tmj",399.58755408000007,399.58755408000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0386",null,"Max ultrasound image capture",476.29357776000006,476.29357776000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0415",null,"Collection of microorganisms","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D0473",null,"Micro exam, prep & report","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D0482",null,"Direct immunofluorescence","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D0603",null,"Caries risk assess high risk",74.920697280000013,74.920697280000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D0701",null,"Pano radio image"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D0999",null,"Unspecified diagnostic proce"," By Report "," By Report ","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D1351",null,"Dental sealant per tooth","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D1527",null,"Remove bilat space main, man","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D1999",null,"Unspecified preventive proc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D2393",null,"Post 3 srfc resinbased cmpst",295.22997504000006,295.22997504000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2543",null,"Dental onlay metallic 3 surf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2651",null,"Inlay composite/resin two su","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2740",null,"Crown porcelain/ceramic",1183.59788976,1183.59788976,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D2753",null,"Crown porc fused to titanium","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D2792",null,"Crown full cast noble metal",1109.56985568,1109.56985568,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D2931",null,"Prefab stnlss steel crown pe",319.31087760000003,319.31087760000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2951",null,"Tooth pin retention",80.276676480000006,80.276676480000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2980",null,"Crown repair",300.58595424000009,300.58595424000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D3240",null,"Pulpal therapy posterior pri","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D3346",null,"Retreat root canal anterior",894.61655712000004,894.61655712000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D3421",null,"Root surgery premolar",841.99143600000002,841.99143600000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D3450",null,"Root amputation",523.56271967999999,523.56271967999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D3471",null,"Surg rep root res anterior","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D4211",null,"Gingivectomy/plasty 1 to 3",341.60645375999997,341.60645375999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D4249",null,"Crown lengthen hard tissue",800.96043455999995,800.96043455999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D4274",null,"Mesial/distal wedge proc",686.79406224000013,686.79406224000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D4355",null,"Full mouth debridement","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,8]
["D5120",null,"Dentures complete mandible",1843.6330598400002,1843.6330598400002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5140",null,"Dentures immediat mandible",1938.1713436800003,1938.1713436800003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5411",null,"Dentures adjust cmplt mand",93.656122560000014,93.656122560000014,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5511",null,"Rep broke comp dent base man","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D5670",null,"Replc tth&acrlc on mtl frmwk",773.30887920000009,773.30887920000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5740",null,"Denture reln part maxil chr",385.31544480000002,385.31544480000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5850",null,"Denture tiss conditn maxill",219.41661456000003,219.41661456000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5867",null,"Replacement of precision att",416.53765296,416.53765296,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5923",null,"Ocular prosthesis interim",6052.4455305600013,6052.4455305600013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5925",null,"Facial augmentation implant",6052.4455305600013,6052.4455305600013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5955",null,"Palatal lift prosthesis",4917.6185572800005,4917.6185572800005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5960",null,"Modify speech aid prosthesis",605.23615152000002,605.23615152000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5995",null,"Peri medicament w/seal, max"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D6050",null,"Odontics transosteal implnt",5591.5477675200009,5591.5477675200009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6063",null,"Abutment supported mtl crown",1403.0145043200002,1403.0145043200002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6070",null,"Abutment supported retainer",1403.0145043200002,1403.0145043200002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6085",null,"Provisional implant crown"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D6087",null,"Implant crown noble alloys"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D6097",null,"Abut crown porc to titanium"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D6111",null,"Implnt/abut remov dent mand",2937.14547984,2937.14547984,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D6123",null,"Retain metal fpd titanium"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D6210",null,"Prosthodont high noble metal",1147.9228675200002,1147.9228675200002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6251",null,"Bridge resin base metal",1096.1904096000001,1096.1904096000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6603",null,"Cst hgh nble mtl inlay >=3sr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6612",null,"Onlay cst base mtl 2 surface","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6615",null,"Onlay cst nbl mtl >=3 surfac","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6751",null,"Crown porcelain base metal",1097.0830728000001,1097.0830728000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6791",null,"Crown full base metal cast",1101.5358868800001,1101.5358868800001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6999",null,"Fixed prosthodontic proc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D7250",null,"Tooth root removal",320.20354080000004,320.20354080000004,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D7288",null,"Brush biopsy",219.41661456000003,219.41661456000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7310",null,"Alveoplasty w/ extraction",316.63288800000004,316.63288800000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7413",null,"Excision malig lesion<=1.25c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D7471",null,"Rem exostosis any site",773.30887920000009,773.30887920000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7521",null,"Incision/drain abscess extra",666.27331056000003,666.27331056000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7550",null,"Removal of sloughed off bone",609.19537536000007,609.19537536000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7680",null,"Reduct simple facial bone fx",6802.7972126400009,6802.7972126400009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7771",null,"Alveolus clsd reduc stblz te",1939.9566700800001,1939.9566700800001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7860",null,"Tmj cutting into joint",2269.6644484800004,2269.6644484800004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7875",null,"Tmj arthroscopy synovectomy",2912.7495196800005,2912.7495196800005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7940",null,"Reshaping bone orthognathic",4128.7668364800002,4128.7668364800002,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D7951",null,"Sinus aug w bone or bone sub",3151.2061152000001,3151.2061152000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D7971",null,"Excision pericoronal gingiva",281.85052896000002,281.85052896000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D7980",null,"Surgical sialolithotomy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D7997",null,"Appliance removal",369.25800912000005,369.25800912000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D8060",null,"Intercep dental tx transitn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D8695",null,"Remove fixed ortho appliance","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D8703",null,"Replace broken retainer max","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D9223",null,"General anesth ea addl 15 mi","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D9440",null,"Office visit after hours",193.55038560000003,193.55038560000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D9920",null,"Behavior management",156.98270016000001,156.98270016000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D9933",null,"Clean & inspect rem dent man","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D9972",null,"Extrnl bleaching per arch","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D9975",null,"External bleaching home app","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D9997",null,"Dent case mgmt special needs","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["E0113","NU","Crutch underarm each wood",25.1022,25.1022,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0141","RR","Rigid wheeled walker adj/fix",8.5374000000000017,8.5374000000000017,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0147","RR","Walker variable wheel resist",52.089359999999999,52.089359999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0156","RR","Walker seat attachment",2.2266599999999999,2.2266599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0158","NU","Walker leg extenders set of4",28.478400000000001,28.478400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0175","NU","Commode chair foot rest",70.645200000000003,70.645200000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0182","RR","Replace pump, alt press pad",47.067999999999998,47.067999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0186","NU","Air pressure mattress",873.11139999999989,873.11139999999989,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0197","NU","Air pressure pad for mattres",411.84499999999997,411.84499999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0218",null,"Fluid circ cold pad w pump","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0232","RR","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]
["E0241","NU","Bath tub wall rail",41.125518720000002,41.125518720000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0250","NU","Hosp bed fixed ht w/ mattres",2353.3999999999996,2353.3999999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0270","NU","Hospital bed institutional t","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["E0272","NU","Mattress foam rubber",176.1438,176.1438,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0276","NU","Bed pan fracture",13.382399999999999,13.382399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0295","RR","Hosp bed semi-elect w/o matt",141.20400000000001,141.20400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0302","RR","Ex hd hosp bed > 600 lbs",1412.04,1412.04,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0310","NU","Rails bed side full length",161.53740000000002,161.53740000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0316","RR","Bed safety enclosure",284.40879999999999,284.40879999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0371","NU","Nonpower mattress overlay",2328.0656256000002,2328.0656256000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0442","NU","Stationary o2 contents, liq",82.146018240000004,82.146018240000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0446","NU","Topical ox deliver sys, nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0457","RR","Chest shell",163.382570208,163.382570208,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0472","NU","Rad w backup invasive intrfc",8236.9,8236.9,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0483","RR","Hi freq chest wall oscil sys",1882.7199999999998,1882.7199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0555","NU","Humidifier for use w/ regula",5.8875999999999991,5.8875999999999991,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0565","RR","Compressor air power source",54.294599999999996,54.294599999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0600","RR","Suction pump portab hom modl",20.592659999999999,20.592659999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0605","NU","Vaporizer room type",31.365000000000002,31.365000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0617","NU","Automatic ext defibrillator",4118.6429856000004,4118.6429856000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0621","RR","Patient lift sling or seat",10.350960000000001,10.350960000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0638","NU","Standing frame sys",5279.857,5279.857,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0642","RR","Dynamic standing frame"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0656","RR","Segmental pneumatic trunk",74.132099999999994,74.132099999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0666","RR","Pneumatic appliance half leg",16.891199999999998,16.891199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0670","NU","Seg pneum int legs/trunk",1492.5558000000001,1492.5558000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0673","NU","Pressure pneum appl half leg",318.40320000000003,318.40320000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0694",null,"Uvl md cabinet sys 6 ft","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0746","RR","Electromyograph biofeedback","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["E0755",null,"Electronic salivary reflex s","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0770","RR","Functional electric stim nos",929.59300000000007,929.59300000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0783","RR","Programmable infusion pump",972.06816000000003,972.06816000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0791","RR","Parenteral infusion pump sta",353.01,353.01,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0840","NU","Tract frame attach headboard",86.995800000000003,86.995800000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0890","NU","Traction frame attach pelvic",142.953,142.953,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0900","RR","Trac stand free stand pelvic",15.214320000000001,15.214320000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0935","RR","Cont pas motion exercise dev",27.009600000000002,27.009599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0945","NU","Belt/harness extremity",52.621800000000007,52.621800000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0955","NU","Cushioned headrest",294.17499999999995,294.17499999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0958","NU","Whlchr att- conv 1 arm drive",1027.7141999999999,1027.7141999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0968","NU","Wheelchair commode seat",470.67999999999995,470.67999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0969","RR","Wheelchair narrowing device",18.596640000000001,18.596640000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0982","NU","Back upholstery, replacement",49.786200000000001,49.786200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0983","RR","Add pwr joystick",470.67999999999995,470.67999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0992","RR","Wheelchair solid seat insert",10.03068,10.03068,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1003","NU","Pwr seat recline",5883.5,5883.5,"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]
["E1014",null,"Reclining back add ped w/c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1030","RR","W/c vent tray gimbaled",129.43699999999998,129.43699999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1035","NU","Patient transfer system <300",5688.0814161600001,5688.0814161600001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1084","NU","Hemi-wheelchair detachable a",575.41039999999998,575.41039999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1086","NU","Hemi-wheelchair detachable a",2288.6855999999998,2288.6855999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1088","RR","Wheelchair lightweight det a",294.17500000000001,294.17500000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1110","RR","Wheelchair semi-recl detach",141.20400000000001,141.20400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1170","RR","Whlchr ampu fxd arm leg rest",176.505,176.505,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1180","RR","Wheelchair amputee w/ foot r",188.27199999999999,188.27199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1200","NU","Wheelchair amputee fixed arm",1235.5349999999999,1235.5349999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1226","NU","Manual fully reclining back",531.34859999999992,531.34859999999992,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1235",null,"Rigid ped wc adjustable","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1239",null,"Ped power wheelchair nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1260","NU","Wheelchair lightwt foot rest",588.34999999999991,588.34999999999991,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1297","NU","Wheelchair special seat dept",124.2054,124.2054,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1300",null,"Whirlpool portable","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1391","RR","Oxygen concentrator, dual",146.56379999999999,146.56379999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1406","RR","O2/water vapor enrich w/o he",159.34440000000001,159.34440000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1594","RR","Cycler dialysis machine",933.49620000000004,933.49620000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1630","RR","Reciprocating peritoneal dia","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1800","RR","Adjust elbow ext/flex device",145.452,145.452,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1805","RR","Adjust wrist ext/flex device",150.02160000000001,150.02160000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1841","RR","Static str shldr dev rom adj",537.85619999999994,537.85619999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2101","NU","Bld glucose monitor w lance",223.87980000000002,223.87980000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2207","RR","Crutch and cane holder",5.0541,5.0541,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2209","NU","Arm trough each",100.2864,100.2864,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2220","NU","Solid propuls tire, repl, ea",32.792999999999999,32.792999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2227","NU","Gear reduction drive wheel",3883.1099999999997,3883.1099999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2295",null,"Ped dynamic seating frame","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E2301","NU","Pwr standing","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["E2323","NU","Special joystick handle",69.961800000000011,69.961800000000011,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2325","NU","Sip and puff interface",2196.9029999999998,2196.9029999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2340","RR","W/c wdth 20-23 in seat frame",42.549300000000002,42.549300000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2342","NU","W/c dpth 20-21 in seat frame",531.91980000000001,531.91980000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2362","NU","Gr24 nonsealed leadacid",109.548,109.548,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2365","NU","U1 sealed leadacid battery",99.215400000000002,99.215400000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2371","NU","Gr27 sealed leadacid battery",153.27540000000002,153.27540000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2375","RR","Non-expandable controller",110.88777999999999,110.88777999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2383","RR","Insert, pneum wheel drive",14.73288,14.73288,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2385","NU","Tube, pneumatic caster tire",47.593199999999996,47.593199999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2392","RR","Solid caster tire, integrate",5.0551200000000005,5.0551200000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2395","NU","Caster wheel excludes tire",51.652799999999999,51.652799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2402","RR","Neg press wound therapy pump",1244.8284000000001,1244.8284000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["E2512","NU","Sgd accessory, mounting sys",1400.2729999999999,1400.2729999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2604","NU","Skin protect wc cus wd>=22in",175.83779999999999,175.83779999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2611","NU","Gen use back cush wdth <22in",245.12639999999999,245.12639999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2623","NU","Adj skin pro wc cus wd>=22in",415.92539999999997,415.92539999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2631","NU","Elevat proximal arm support",287.91539999999998,287.91539999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["G0008",null,"Admin influenza virus vac","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["G0071",null,"Comm svcs by rhc/fqhc 5 min","Not Covered","Not Covered","000",0,0,0,0,9,9,9,9,9,null,"X",null,null,2]
["G0083",null,"Care man h v ext pt 45 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0106","TC","Colon ca screen;barium enema",312.08099999999996,312.08099999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G0117",null,"Glaucoma scrn hgh risk direc","Bundled","Bundled","000",0,0,0,0,0,0,0,0,0,null,"B",null,null,2,28]
["G0121",null,"Colon ca scrn not hi rsk ind",619.53,315.55500000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2]
["G0145",null,"Scr c/v cyto,thinlayer,rescr",37.615799999999993,37.615799999999993,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
["G0158",null,"Hhc ot assistant ea 15","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,11]
["G0168",null,"Wound closure by adhesive",224.65199999999999,26.055,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2]
["G0180",null,"Md certification hha patient","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0219",null,"Pet img wholbod melano nonco","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2,26]
["G0238",null,"Oth resp proc, indiv",19.106999999999999,19.106999999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
["G0252",null,"Pet imaging initial dx","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2,26]
["G0257",null,"Unsched dialysis esrd pt hos","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["G0282",null,"Elect stim wound care not pd","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,25]
["G0293",null,"Non-cov surg proc,clin trial","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0328",null,"Fecal blood scrn immunoassay","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0340",null,"Robt lin-radsurg fractx 2-5","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0390",null,"Trauma respons w/hosp criti","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["G0403",null,"Ekg for initial prevent exam","Not Covered","Not Covered","000",0,0,0,4,0,0,0,0,0,null,"X",null,null,2]
["G0412",null,"Open tx iliac spine uni/bil",1256.4299999999998,1256.4299999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",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,2,29]
["G0435",null,"Oral hiv-1/hiv-2 screen",17.011600000000001,17.011600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
["G0439",null,"Ppps, subseq visit","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0455",null,"Fecal microbiota prep instil","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]
["G0482",null,"Drug test def 15-21 classes",282.21080000000001,282.21080000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC",2,23]
["G0495",null,"Rn care train/edu in hh","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,11]
["G0511",null,"Ccm/bhi by rhc/fqhc 20min mo","Not Covered","Not Covered","000",0,0,0,0,9,9,9,9,9,null,"X",null,null,2,22]
["G0514",null,"Prolong prev svcs, addl 30m",111.16799999999999,104.22,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
["G1007",null,"Cdsm aim","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1011",null,"Cdsm qualified nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2003",null,"Post-d/c h vst new pt 45 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2006",null,"Post-d/c h vst ext pt 20 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2022",null,"Benef refuses service, mod","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2067",null,"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,"Take-hom buprenorphine","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2088",null,"Off base opioid tx, add30","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2100",null,"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]
["G2106",null,"Pt 66+ lt ints > 90","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2128",null,"No aspirin med rsn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2137",null,"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]
["G2145",null,"Fsodi 6-20wk >22 or chg 30pt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2169",null,"Svs by ot in home health","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2181",null,"Bmi not doc medrsn ptref","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2188",null,"Pt 50 yrs w/clin ind hd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2199",null,"Not scrn etoh no rsn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2207",null,"Rsn no trtmt chem her2","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2250",null,"Remot img sub by pt, non e/m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G6001",null,"Echo guidance radiotherapy",276.762,276.762,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
["G6005",null,"Radiation treatment delivery",260.55,260.55,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
["G6015",null,"Radiation tx delivery imrt",693.06299999999999,693.06299999999999,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
["G8410",null,"Eval on foot documented","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8421",null,"Bmi not calculated","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8465",null,"High risk recurrence pro ca","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8483",null,"Flu imm no admin doc rea","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8542",null,"Doc funct no deficiencies","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8560",null,"Pt hx act drain prev 90 days","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8568",null,"Pt no ref otolo no spec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8601",null,"No elig tpa init w/in 3 hrs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8654",null,"Rafs crs hi no scor no surv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8664",null,"Rafscrs si scor < 0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8712",null,"Not pres antibiotic","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]
["G8806",null,"Perf ultrsnd to lct preg doc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8807",null,"No ta tv ultrasnd","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]
["G8864",null,"Pneumococcal vaccine admin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8880",null,"Sen lym p node biop not perf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8911",null,"Pt doc no fall in asc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8915",null,"Pt not trans to hosp at d/c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8946",null,"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]
["G8950",null,"Pre-htn or htn doc, f/u indc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8964",null,"Csi any other than pci 2 yr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9005",null,"Mccd, risk adj, maintenance","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["G9051",null,"Oncology tx decision-mgmt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9058",null,"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,"Onc dx sclc/nsclc limited","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9072",null,"Onc dx brst stg1-2 noprogres","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]
["G9093",null,"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]
["G9100",null,"Onc dx gastric no recurrence","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9111",null,"Onc dx head/neck m1 mets rec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9129",null,"Onc dx mult myeloma stg2 hig","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9136",null,"Onc dx nhl trans to lg bcell","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]
["G9212",null,"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]
["G9243",null,"Doc viral load <200","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9250",null,"Doc of pain comfort 48hr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9270",null,"Doc no comp or mort w in 90d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9283",null,"Hist type doc on report","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9295",null,"Non cutaneous loc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9307",null,"No ret for surg w in 30d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9318",null,"Image std nomenclature","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9345",null,"Follow up pulm nod","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9357",null,"Pp eval/edu perf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9360",null,"No doc of neg or man pos tb","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9384",null,"Doc med rsn no hcv scrn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9402",null,"Recd f/u w/in 30d disch","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9409",null,"No card tamp e/in 30d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9421",null,"Lung cx bx rpt no doc class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9432",null,"Asth controlled","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9454",null,"No scr hcv inf 12 mth rp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9473",null,"Chap services at hospice","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9476",null,"Volun service at hospice","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9501",null,"Rad expos ind/exp tm no doc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9512",null,"Indiv pdc > 0.8","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]
["G9541",null,"Filter rem 3 mon plmt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9555",null,"Doc med rsn for follup image","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9579",null,"No doc opioid tx 1x at ther","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9597",null,"No low pecarn ped head traum","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9598",null,"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]
["G9609",null,"Doc order anti-plat","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9625",null,"Pt 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]
["G9634",null,"Qual life tool 2x same/impr","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]
["G9659",null,">85y no hx colo ca/rsn scope","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9668",null,"DOC MED RSN NO STAT TX/PRESC","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9693",null,"Pt use hosp during msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9694",null,"Hosp srv used pt in msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9703",null,"Child anbx 30 prior dx phary","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9715",null,"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]
["G9724",null,"Pt w/doc use anticoag mst yr","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]
["G9751",null,"Pt died w/in 24 mos rpt time","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9760",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]
["G9772",null,"Doc med rsn no temp >= 35.5","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9773",null,"1 bod temp >=35.5","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9781",null,"Doc rsn no statin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9792",null,"Most rct tob stat not free","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9806",null,"Pt recd cerv cyto/hpv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9822",null,"Endo abl proc yr prev ind dt","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]
["G9853",null,"Icu stay last 30d life","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]
["G9904",null,"Doc med rsn no tbco scrn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9911",null,"Node neg pre/post syst ther","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9923",null,"Safty cncrns scrn and neg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9930",null,"Com care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9954",null,"Pt >2 rsk fac post-op vomit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9965",null,"No well-chld vist recv by pt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9977",null,"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]
["H0003",null,"Alcohol and/or drug screenin","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["H0013",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]
["H0020",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]
["H0032",null,"Mh svc plan dev by non-md","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0038",null,"Self-help/peer svc per 15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H0050",null,"Alcohol/drug service 15 min","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["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]
["H2021",null,"Com wrap-around sv, 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["H2035",null,"A/d tx program, per hour","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]
["J0179",null,"Inj, brolucizumab-dbll, 1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0205",null,"Alglucerase injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0278",null,"Amikacin sulfate injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0300",null,"Amobarbital 125 mg inj",791.69,791.69,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0380",null,"Inj metaraminol bitartrate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0401",null,"Inj aripiprazole ext rel 1mg",5.7039999999999997,5.7039999999999997,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0561",null,"Penicillin g benzathine inj",15.228,15.228,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0572",null,"Bupren/nal up to 3mg bupreno","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J0588",null,"Incobotulinumtoxin a",5.0590000000000002,5.0590000000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0597",null,"C-1 esterase, berinert","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0641",null,"Inj levoleucovorin nos 0.5mg",0.124,0.124,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0697",null,"Sterile cefuroxime injection",1.9850000000000001,1.9850000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0698",null,"Cefotaxime sodium injection",2.3319999999999999,2.3319999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0716",null,"Centruroides immune f(ab)",5395.99,5395.99,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,16]
["J0834",null,"Inj., cosyntropin, 0.25 mg",34.345999999999997,34.345999999999997,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0878",null,"Daptomycin injection",9.4E-2,9.4E-2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0894",null,"Decitabine injection",3.4630000000000001,3.4630000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1071",null,"Inj testosterone cypionate",2.8000000000000001E-2,2.8000000000000001E-2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1160",null,"Digoxin injection",5.1189999999999998,5.1189999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1201",null,"Inj. cetirizine hcl 0.5mg",16.2,16.2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1250",null,"Inj dobutamine hcl/250 mg",7.7089999999999996,7.7089999999999996,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1303",null,"Inj., ravulizumab-cwvz 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1427",null,"Inj. viltolarsen","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1438",null,"Etanercept injection",201.43,201.43,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1457",null,"Gallium nitrate injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1560",null,"Gamma globulin > 10 cc inj",431.75700000000001,431.75700000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1572",null,"Flebogamma injection",36.079000000000001,36.079000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1602",null,"Golimumab for iv use 1mg",17.149999999999999,17.149999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1630",null,"Haloperidol injection",1.4319999999999999,1.4319999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1652",null,"Fondaparinux sodium",2.0459999999999998,2.0459999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1740",null,"Ibandronate sodium injection",38.545000000000002,38.545000000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1750",null,"Inj iron dextran",15.074,15.074,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1890",null,"Cephalothin sodium injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1945",null,"Lepirudin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1990",null,"Chlordiazepoxide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2185",null,"Meropenem",0.78500000000000003,0.78500000000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2270",null,"Morphine sulfate injection",2.996,2.996,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2280",null,"Inj, moxifloxacin 100 mg",9.64,9.64,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2355",null,"Oprelvekin injection","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J2407",null,"Injection, oritavancin",23.628,23.628,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2505",null,"Injection, pegfilgrastim 6mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2543",null,"Piperacillin/tazobactam",1.508,1.508,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2690",null,"Procainamide hcl injection",84.369,84.369,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2778",null,"Ranibizumab injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2791",null,"Rhophylac injection",4.7530000000000001,4.7530000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2795",null,"Ropivacaine hcl injection",8.3000000000000004E-2,8.3000000000000004E-2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2930",null,"Methylprednisolone injection",5.7930000000000001,5.7930000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2950",null,"Promazine hcl injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3095",null,"Telavancin injection",5.851,5.851,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3145",null,"Testosterone undecanoate 1mg",1.589,1.589,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3300",null,"Triamcinolone a inj prs-free",3.8660000000000001,3.8660000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3305",null,"Inj trimetrexate glucoronate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3370",null,"Vancomycin hcl injection",2.9279999999999999,2.9279999999999999,"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]
["J3475",null,"Inj magnesium sulfate",0.59899999999999998,0.59899999999999998,"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]
["J7100",null,"Dextran 40 infusion","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J7121",null,"5% dextrose in lac ringers","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J7185",null,"Xyntha inj",1.2569999999999999,1.2569999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7190",null,"Factor viii",1.01,1.01,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7202",null,"Factor ix idelvion inj",4.59,4.59,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7207",null,"Factor viii pegylated recomb",1.863,1.863,"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]
["J7312",null,"Dexamethasone intra implant",200.06,200.06,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7327",null,"Monovisc inj per dose",709.05200000000002,709.05200000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7330",null,"Cultured chondrocytes implnt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,"Y-CM",2,16]
["J7503",null,"Tacrol envarsus ex rel oral",1.4359999999999999,1.4359999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7509",null,"Methylprednisolone oral",0.29399999999999998,0.29399999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7516",null,"Cyclosporin parenteral 250mg",49.567999999999998,49.567999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7609",null,"Albuterol comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7628",null,"Bitolterol mesylate comp con","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7634",null,"Budesonide comp con","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7648",null,"Isoetharine non-comp con","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7660",null,"Isoproterenol comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7668",null,"Metaproterenol non-comp con","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7686",null,"Treprostinil, non-comp unit",671.30700000000002,671.30700000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",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]
["J8610",null,"Methotrexate oral 2.5 mg",0.222,0.222,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9000",null,"Doxorubicin hcl injection",2.6549999999999998,2.6549999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9025",null,"Azacitidine injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9050",null,"Carmustine injection",1724.364,1724.364,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9098",null,"Cytarabine liposome inj",640.93740000000003,640.93740000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,16]
["J9119",null,"Inj., cemiplimab-rwlc, 1 mg",27.39,27.39,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J9178",null,"Inj, epirubicin hcl, 2 mg",1.6910000000000001,1.6910000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9200",null,"Floxuridine injection",63.77,63.77,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9207",null,"Ixabepilone injection",111.858,111.858,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9214",null,"Interferon alfa-2b inj",34.131999999999998,34.131999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9229",null,"Inj inotuzumab ozogam 0.1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9263",null,"Oxaliplatin",0.121,0.121,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9270",null,"Plicamycin (mithramycin) inj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9299",null,"Injection, nivolumab","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9320",null,"Streptozocin injection",347.62200000000001,347.62200000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9351",null,"Topotecan injection",1.1739999999999999,1.1739999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J9358",null,"Inj fam-trastu deru-nxki 1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J9600",null,"Porfimer sodium injection",22723.200000000001,22723.200000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["K0005","RR","Ultralightweight wheelchair",219.51419999999999,219.51419999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0009","NU","Other manual wheelchair/base",907.15584960000001,907.15584960000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0012","NU","Ltwt portbl power whlchr",3294.7599999999998,3294.7599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0015","NU","Detach non-adj ht armrst rep",177.09539999999998,177.09539999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0040","NU","Adjustable angle footplate",66.830399999999997,66.830399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0043","RR","Ftrst lowr exten tube rep ea",1.97472,1.97472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0045","RR","Ftrst compl assembly repl ea",5.0541,5.0541,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0056","RR","Seat ht <17 or >=21 ltwt wc",10.69266,10.69266,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0077","NU","Fr cstr asmb sol tire rep ea",64.249800000000008,64.249800000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0455","NU","Pump uninterrupted infusion",3231.4407840000003,3231.4407840000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0601","NU","Repl batt silver oxide 1.5 v",1.3056000000000001,1.3056000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0733","RR","12-24hr sealed lead acid",3.0916199999999998,3.0916199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0744","NU","Absorp drg <= 16 suc pump","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["K0807","NU","Pov group 2 hd 301-450 lbs",2317.5012000000002,2317.5012000000002,"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",3460.3826400000003,3460.3826400000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0826","NU","Pwc gp 2 vhd seat/back",8135.7324048,8135.7324048,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0828","RR","Pwc gp 2 xtra hd seat/back",940.52044944000011,940.52044944000011,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0838","NU","Pwc gp 2 hd sing pow opt cap",4900.6159488000003,4900.6159488000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0839","RR","Pwc gp2 vhd sing pow opt s/b",725.65116623999995,725.65116623999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0850","NU","Pwc gp 3 hd seat/back",9668.5926479999998,9668.5926479999998,"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",1117.1522419199998,1117.1522419199998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0855","RR","Pwc gp 3 xhd cap chair",1436.16906576,1436.16906576,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0861","RR","Pwc gp3 std mult pow opt s/b",896.12883360000012,896.12883360000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0870","RR","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]
["K0878","NU","Pwc gp4 std sing pow opt cap","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0891","RR","Pwc gp5 ped mult pow opt s/b","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1001","NU","Electronic posa treatment","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,9]
["K1002","RR","Ces system w/supplies access","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1015",null,"Foot, adductus position, adj","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L0112",null,"Cranial cervical orthosis",1672.9859999999999,1672.9859999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0200",null,"Cerv col supp adj bar & thor",757.16859999999997,757.16859999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0466",null,"Tlso r fram soft ant pre cst",540.25259999999992,540.25259999999992,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L0472",null,"Tlso rigid frame hyperex pre",552.69659999999999,552.69659999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0625",null,"Lo flex l1-below l5 pre ots",57.596200000000003,57.596200000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0631",null,"Lso sag r an/pos pnl pre cst",1227.076,1227.076,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0634",null,"Lso flexion control custom","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["L0650",null,"Lso sc r ant/pos pnl pre ots",1203.8471999999999,1203.8471999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0830",null,"Halo cerv into milwaukee typ",4336.9780000000001,4336.9780000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1000",null,"Ctlso milwauke initial model",2784.4548,2784.4548,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1040",null,"Lumbar or lumbar rib pad",110.49539999999999,110.49539999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1210",null,"Lateral thoracic extension",299.63200000000001,299.63200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1600",null,"Ho flex frejka w/cov pre cst",147.559,147.559,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1652",null,"Ho bi thighcuffs w sprdr bar",426.08499999999998,426.08499999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1685",null,"Post-op hip abduct custom fa",1362.0934,1362.0934,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1836",null,"Ko rigid w/o joints pre ots",142.71559999999999,142.71559999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1843",null,"Ko single upright pre cst",1072.5142000000001,1072.5142000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1904",null,"Afo molded ankle gauntlet",538.47140000000002,538.47140000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1940",null,"Afo molded to patient plasti",608.36520000000007,608.36520000000007,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2006",null,"Kaf sng/dbl swg/stn mcpr cus","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L2038",null,"Kafo w/o joint multi-axis an",1904.7737999999999,1904.7737999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2114",null,"Afo tib fx semi-rigid",679.71079999999995,679.71079999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2128",null,"Kafo fem fx cast molded to p",2618.0711999999999,2618.0711999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2240",null,"Round caliper and plate atta",96.672799999999995,96.672799999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2260",null,"Reinforced solid stirrup",229.55519999999999,229.55519999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2335",null,"Anterior swing band",284.80899999999997,284.80899999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2390",null,"Offset knee joint each",125.355,125.355,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2526",null,"Th/wght bear nar m-l brim cu",1045.7840000000001,1045.7840000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2620",null,"Pelvic control hip heavy dut",360.14400000000001,360.14400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2680",null,"Thorac cont lat support upri",179.1936,179.1936,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2810",null,"Knee control condylar pad",89.438199999999995,89.438199999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2861",null,"Torsion mechanism knee/ankle",450.61468200000002,450.61468200000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3020",null,"Foot longitud/metatarsal sup",237.14359999999999,237.14359999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3100",null,"Hallus-valgus nt dyn pre ots",51.679200000000002,51.679200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3206",null,"Hightop w/ supp/pronator chi","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L3221",null,"Orthopedic mens shoes dpth i",138.59100000000001,138.59100000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3253",null,"Shoe molded plastazote cust",73.384499999999989,73.384499999999989,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3332",null,"Shoe lifts tapered to one-ha",88.144999999999996,88.144999999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3410",null,"Shoe metatarsal bar between",110.959,110.959,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3480",null,"Shoe heel pad & depress for",74.480999999999995,74.480999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3510",null,"Orthopedic shoe add rub insl",34.965200000000003,34.965200000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3595",null,"Ortho shoe add march bar",50.142000000000003,50.142000000000003,"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",131.71119999999999,131.71119999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3740",null,"Cuffs adj lock w/ active con",1202.3222000000001,1202.3222000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3900",null,"Hinge extension/flex wrist/f",1631.8719999999998,1631.8719999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3913",null,"Hfo w/o joints cf",294.63,294.63,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3925",null,"Fo pip dip jnt/sprng pre ots",69.539999999999992,69.539999999999992,"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",1827.6941999999999,1827.6941999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3967",null,"Sewho airplane w/o jnts cf",2157.8872000000001,2157.8872000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3999",null,"Upper limb orthosis nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N","Y",null,2,9]
["L4045",null,"Replace non-molded thigh lac",378.91979999999995,378.91979999999995,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4205",null,"Ortho dvc repair per 15 min",42.63,42.63,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4392",null,"Replace afo soft interface",27.657400000000003,27.657400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L5100",null,"Molded socket shin sach foot",3548.3164999999999,3548.3164999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5160",null,"Mold socket bent knee shin s",6317.4625999999998,6317.4625999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5430",null,"Postop dsg ak ea add cast ch",640.29590000000007,640.29590000000007,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5460",null,"Postop app non-wgt bear dsg",741.89589999999998,741.89589999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5590",null,"Prep ak ischial laminated",3209.3661999999999,3209.3661999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5616",null,"Ak univ multiplex sys frict",1724.8251000000002,1724.8251000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5632",null,"Symes type ptb brim design s",375.97080000000005,375.97080000000005,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5642",null,"Above knee leather socket",1049.1089000000002,1049.1089000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5653",null,"Knee disart expand wall sock",908.40559999999994,908.40559999999994,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5656",null,"Socket insert knee articulat",628.11659999999995,628.11659999999995,"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",802.95749999999998,802.95749999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5684",null,"Bk fork strap",81.495900000000006,81.495900000000006,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5700",null,"Replace socket below knee",4637.1510000000007,4637.1510000000007,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5707",null,"Custom shape cvr hip disart",1791.3223,1791.3223,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5780",null,"Knee-shin pneum/hydra pneum",1453.9976000000001,1453.9976000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5811",null,"Endo knee-shin mnl lck ultra",926.2109999999999,926.2109999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5845",null,"Knee-shin sys stance flexion",2234.5904,2234.5904,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5855",null,"Mech hip extension assist",522.9479,522.9479,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5968",null,"Multiaxial ankle w dorsiflex",4530.5218000000004,4530.5218000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5970",null,"Foot external keel sach foot",311.50560000000002,311.50560000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5988",null,"Vertical shock reducing pylo",2490.5969999999998,2490.5969999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6000",null,"Part hand thumb rem",2249.8685,2249.8685,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6205",null,"Elbow molded w/ expand inter",5636.1076000000003,5636.1076000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6380",null,"Postop dsg cast chg wrst/elb",1736.6361000000002,1736.6361000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6580",null,"Wrist/elbow bowden cable mol",2287.6637000000001,2287.6637000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6586",null,"Elbow fair lead cable dir fo",2639.8093000000003,2639.8093000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6630",null,"Stainless steel any wrist",273.6977,273.6977,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6635",null,"Lift assist for elbow",239.9665,239.9665,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6648",null,"Ext pwrd shlder lock/unlock",4055.4656000000004,4055.4656000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6677",null,"Ue triple control harness",369.83670000000001,369.83670000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6694",null,"Elbow socket ins use w/lock",909.70099999999991,909.70099999999991,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6707",null,"Term dev mech hook vol close",1785.9756,1785.9756,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6805",null,"Term dev modifier wrist unit",537.14649999999995,537.14649999999995,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6895",null,"Custom glove for term device",787.34920000000011,787.34920000000011,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6940",null,"Elbow disarticulation switch",12837.198100000001,12837.198100000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6955",null,"Above elbow myoelectronic ct",15167.902099999999,15167.902099999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L7045",null,"Pediatric electric hook","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X","Y",null,2,9]
["L7360",null,"Six volt bat otto bock/eq ea",337.0453,337.0453,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L7404",null,"Add ue prost a/e acrylic",692.96280000000002,692.96280000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L7902",null,"Tension ring, vac erect dev",25.204608,25.204608,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L8039",null,"Breast prosthesis nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["L8048",null,"Unspec maxillofacial prosth","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["L8417",null,"Pros sheath/sock w gel cushn",93.764099999999999,93.764099999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8430",null,"Prosthetic sock multi ply ak",29.095700000000001,29.095700000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8512",null,"Gel cap for trach voice pros",2.6924000000000001,2.6924000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8515",null,"Gel cap app device for trach",78.676500000000004,78.676500000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8612",null,"Aqueous shunt prosthesis",919.77210000000002,919.77210000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8621",null,"Repl zinc air battery",0.77469999999999994,0.77469999999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["L8658",null,"Interphalangeal joint spacer",516.80110000000002,516.80110000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8685",null,"Implt nrostm pls gen sng rec",23925.87,23925.87,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["L8694",null,"Aoi transducer/actuator repl",1177.3661999999999,1177.3661999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",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]
["M1004",null,"Doc med rsn no srn tb","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1007",null,">=50% total pt outpt ra enct","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1018",null,"Pt dx hst cr pt sk lg cr scr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1028",null,"Doc of pt prm hda dx and otr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1041",null,"Pt cr ft inf lm or pt id sl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1054",null,"Pt uc in pp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1106",null,"Start eoc doc med rec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1108",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]
["M1124",null,"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]
["M1127",null,"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,"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]
["P2029",null,"Congo red blood test",7.0289999999999999,7.0289999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
["P9017",null,"Plasma 1 donor frz w/in 8 hr","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
["P9032",null,"Platelets, irradiated","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
["P9045",null,"Albumin (human), 5%, 250 ml",52.45,52.45,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["P9047",null,"Albumin (human), 25%, 50ml",52.45,52.45,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["P9099",null,"Blood component/product noc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["P9604",null,"One-way allow prorated trip","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["Q0081",null,"Infusion ther other than che","Facility Only","Facility Only","000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["Q0144",null,"Azithromycin dihydrate, oral","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,24]
["Q0175",null,"Perphenazine 4mg oral",0.01,0.01,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,24]
["Q0477",null,"Pwr module pt cable lvad rpl",105.41827296,105.41827296,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["Q0489",null,"Pwr pck base combo vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0495",null,"Charger elec/combo vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0500",null,"Filters elec/combo vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q0510",null,"Dispens fee immunosupressive","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]
["Q2049",null,"Imported lipodox inj","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["Q4003",null,"Cast sup shoulder cast plstr",37.502356320000004,37.502356320000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4010",null,"Cast sup sht arm adult fbrgl",20.783299679999999,20.783299679999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4022",null,"Cast sup sht arm splint fbrg",12.9698712,12.9698712,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4028",null,"Cast sup hip spica ped fbrgl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["Q4033",null,"Cast sup lng leg cylinder pl",28.775260800000002,28.775260800000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4042",null,"Cast sup lng leg splnt fbrgl",36.42065856,36.42065856,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4049",null,"Finger splint, static",2.2474108800000003,2.2474108800000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28]
["Q4107",null,"Graftjacket","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q4113",null,"Graftjacket xpress","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q4130",null,"Strattice tm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4140",null,"Biodfence 1cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4148",null,"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]
["Q4153",null,"Dermavest, plurivest sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4162",null,"Wndex flw, bioskn flw, 0.5cc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4173",null,"Palingen or palingen xplus","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4181",null,"Amnio wound, per square cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4209",null,"Surgraft per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4226",null,"Myown harv prep proc sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4235",null,"Amniorepair or altiply sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4237",null,"Cryo-cord, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q5002",null,"Hospice/home hlth in asst lv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,11]
["Q5005",null,"Hospice, inpatient hospital","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,11]
["Q5112",null,"Inj ontruzant 10 mg",80.164000000000001,80.164000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["Q5120",null,"Inj pegfilgrastim-bmez 0.5mg",276.82400000000001,276.82400000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["Q9955",null,"Inj perflexane lip micros,ml","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["Q9962",null,"Hocm 300-349mg/ml iodine,1ml","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,26]
["R0075","UP","Transport port x-ray multipl",62.675458560000003,62.675458560000003,"000",0,0,0,3,0,0,0,0,0,null,"F",null,null,2,26]
["R0075","UR","Transport port x-ray multipl",37.596873599999995,37.596873599999995,"000",0,0,0,3,0,0,0,0,0,null,"F",null,null,2,26]
["S0012",null,"Butorphanol tartrate, nasal","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["S0017",null,"Injection, aminocaproic acid","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["S0032",null,"Injection, nafcillin sodium","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["S0091",null,"Granisetron 1mg",5.4,5.4,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["S0128",null,"Inj follitropin beta 75 iu","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,24]
["S0142",null,"Colistimethate inh sol mg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,24]
["S0172",null,"Chlorambucil 2 mg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,24]
["S0175",null,"Flutamide 125 mg",0.01,0.01,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,24]
["S0208",null,"Paramed intrcept nonvol","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0220",null,"Medical conference by physic","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0265",null,"Genetic counsel 15 mins","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0317",null,"Disease mgmt per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0504",null,"Singl prscrp lens","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0516",null,"Safety frames","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0618",null,"Audiometry for hearing aid","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0810",null,"Photorefractive keratectomy","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]
["S2067",null,"Breast \"stacked\" diep/gap","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]
["S2152",null,"Solid organ transpl pkg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2266",null,"Induced abortion 29-31 wks","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2402",null,"Fetal surg cong cyst malf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2900",null,"Robotic surgical system","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["S3620",null,"Newborn metabolic screening","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]
["S3850",null,"Gene test sickle cell","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4014",null,"Compl zift case rate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4020",null,"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]
["S4981",null,"Insert levonorgestrel ius","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4993",null,"Contraceptive pills for bc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5102",null,"Adult day care per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5111",null,"Family homecare train/sessio","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]
["S5162",null,"Emer rspns system purchase","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["S5502",null,"Hit interim cath care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5520",null,"Hit picc insert kit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8030",null,"Tantalum ring application","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8040",null,"Topographic brain mapping","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8121",null,"O2 contents liquid lb","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8186",null,"Swivel adaptor","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8189",null,"Trach supply noc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8210",null,"Mucus trap","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",2,28]
["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,2,28]
["S8421",null,"Ready gradient sleev/glov","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8422",null,"Custom grad sleeve med","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8423",null,"Custom grad sleeve heavy","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8424",null,"Ready gradient sleeve","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8425",null,"Custom grad glove med","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8426",null,"Custom grad glove heavy","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8427",null,"Ready gradient glove","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8428",null,"Ready gradient gauntlet","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8429",null,"Gradient pressure wrap","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8430",null,"Padding for comprssn bdg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["S8431",null,"Compression bandage","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["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",32.089199999999998,32.089199999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,11]
["S9123",null,"Nursing care in home rn",64.523796480000001,64.523796480000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,11]
["S9124",null,"Nursing care, in the home; b",46.607520960000002,46.607520960000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,11]
["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,2,11]
["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,2,11]
["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,2,11]
["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,2,11]
["S9129",null,"Occupational therapy, in the","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,11]
["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,2,11]
["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]
["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",43.35192576,43.35192576,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",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","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["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]
["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",28.071632160000004,28.071632160000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["S9982",null,"Med record copy per page",0.55660176000000006,0.55660176000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,27]
["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]
["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]
["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","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4522",null,"Adult size brief/diaper med","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4523",null,"Adult size brief/diaper lg","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4524",null,"Adult size brief/diaper xl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4525",null,"Adult size pull-on sm","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4526",null,"Adult size pull-on med","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4527",null,"Adult size pull-on lg","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4528",null,"Adult size pull-on xl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["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","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4534",null,"Youth size pull-on","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4535",null,"Disposable liner/shield/pad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4536",null,"Reusable pull-on any size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4537",null,"Reusable underpad bed size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["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","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4540",null,"Reusable underpad chair size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4541",null,"Large disposable underpad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4542",null,"Small disposable underpad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["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","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["T4545",null,"Incon disposable penile wrap","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,28]
["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",37.712394719999999,37.712394719999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,23]
["U0002",null,"Covid-19 lab test non-cdc",53.885351520000007,53.885351520000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,23]
["U0003",null,"SARS-COV-2 DNA/RNA HIGH THROUGHPUT",106.5,106.5,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["U0004",null,"2019-NCOV ANY TECHNIQUE HIGH THROUGHPUT",106.5,106.5,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["U0005",null,"Infec agen detec ampli probe",35.5,35.5,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["V0028",null,"Travel, vocational services, claimant","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2,30]
["V0028",null,"Travel, vocational services, claimant","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2,30]
["V2020",null,"Vision svcs frames purchases","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2101",null,"Single visn sphere 4.12-7.00","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2102",null,"Singl visn sphere 7.12-20.00","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2103",null,"Spherocylindr 4.00d/12-2.00d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2104",null,"Spherocylindr 4.00d/2.12-4d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2105",null,"Spherocylinder 4.00d/4.25-6d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2106",null,"Spherocylinder 4.00d/>6.00d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2107",null,"Spherocylinder 4.25d/12-2d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2108",null,"Spherocylinder 4.25d/2.12-4d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2109",null,"Spherocylinder 4.25d/4.25-6d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2110",null,"Spherocylinder 4.25d/over 6d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2111",null,"Spherocylindr 7.25d/.25-2.25","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2112",null,"Spherocylindr 7.25d/2.25-4d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2113",null,"Spherocylindr 7.25d/4.25-6d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2114",null,"Spherocylinder over 12.00d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2115",null,"Lens lenticular bifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2118",null,"Lens aniseikonic single","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2121",null,"Lenticular lens, single","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2201",null,"Lens sphere bifocal 4.12-7.0","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2202",null,"Lens sphere bifocal 7.12-20.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2203",null,"Lens sphcyl bifocal 4.00d/.1","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2204",null,"Lens sphcy bifocal 4.00d/2.1","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2205",null,"Lens sphcy bifocal 4.00d/4.2","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2206",null,"Lens sphcy bifocal 4.00d/ove","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2207",null,"Lens sphcy bifocal 4.25-7d/.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2208",null,"Lens sphcy bifocal 4.25-7/2.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2209",null,"Lens sphcy bifocal 4.25-7/4.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2210",null,"Lens sphcy bifocal 4.25-7/ov","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2211",null,"Lens sphcy bifo 7.25-12/.25-","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2212",null,"Lens sphcyl bifo 7.25-12/2.2","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2213",null,"Lens sphcyl bifo 7.25-12/4.2","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2214",null,"Lens sphcyl bifocal over 12.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2215",null,"Lens lenticular bifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2218",null,"Lens aniseikonic bifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2219",null,"Lens bifocal seg width over","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2220",null,"Lens bifocal add over 3.25d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2221",null,"Lenticular lens, bifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2301",null,"Lens sphere trifocal 4.12-7.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2302",null,"Lens sphere trifocal 7.12-20","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2303",null,"Lens sphcy trifocal 4.0/.12-","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2304",null,"Lens sphcy trifocal 4.0/2.25","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2305",null,"Lens sphcy trifocal 4.0/4.25","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2306",null,"Lens sphcyl trifocal 4.00/>6","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2307",null,"Lens sphcy trifocal 4.25-7/.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2308",null,"Lens sphc trifocal 4.25-7/2.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2309",null,"Lens sphc trifocal 4.25-7/4.","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2310",null,"Lens sphc trifocal 4.25-7/>6","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2311",null,"Lens sphc trifo 7.25-12/.25-","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2312",null,"Lens sphc trifo 7.25-12/2.25","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2313",null,"Lens sphc trifo 7.25-12/4.25","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2314",null,"Lens sphcyl trifocal over 12","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2315",null,"Lens lenticular trifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2318",null,"Lens aniseikonic trifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2319",null,"Lens trifocal seg width > 28","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2320",null,"Lens trifocal add over 3.25d","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2321",null,"Lenticular lens, trifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2430",null,"Lens variable asphericity bi","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2501",null,"Cntct lens pmma-toric/prism","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2502",null,"Contact lens pmma bifocal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2503",null,"Cntct lens pmma color vision","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2510",null,"Cntct gas permeable sphericl","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2511",null,"Cntct toric prism ballast","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2512",null,"Cntct lens gas permbl bifocl","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2513",null,"Contact lens extended wear","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2520",null,"Contact lens hydrophilic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2521",null,"Cntct lens hydrophilic toric","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2522",null,"Cntct lens hydrophil bifocl","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2523",null,"Cntct lens hydrophil extend","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2524",null,"Cntct lens hydrophil photoch","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2530",null,"Contact lens gas impermeable","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2531",null,"Contact lens gas permeable","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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",122.2572,122.2572,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2631",null,"Iris support intraoclr lens",122.2572,122.2572,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2632",null,"Post chmbr intraocular lens",122.2572,122.2572,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2700",null,"Balance lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2715",null,"Prism lens/es","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2718",null,"Fresnell prism press-on lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2730",null,"Special base curve","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2744",null,"Tint photochromatic lens/es","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2745",null,"Tint, any color/solid/grad","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2750",null,"Anti-reflective coating","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2755",null,"Uv lens/es","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2770",null,"Occluder lens/es","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2780",null,"Oversize lens/es","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2783",null,"Lens, >= 1.66 p/>=1.80 g","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2784",null,"Lens polycarb or equal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",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",87.300307016207981,87.300307016207981,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5010",null,"Assessment for hearing aid","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5,28]
["V5011",null,"Hearing aid fitting/checking","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5,28]
["V5014",null,"Hearing aid repair/modifying",58.203775680336001,58.203775680336001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,5]
["V5020",null,"Conformity evaluation","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"B",null,null,2,5,28]
["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",1652.9529476940481,1652.9529476940481,"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",990.73903458816005,990.73903458816005,"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",990.73903458816005,990.73903458816005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5241",null,"Dispensing fee, monaural",826.47647384702407,826.47647384702407,"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",1.0177358162400001,1.0177358162400001,"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,2,5]
["V5362",null,"Speech screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,5]
["V5363",null,"Language screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,5]
["V5364",null,"Dysphagia screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,5]

{"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/2021/2021MARFSChapter1.pdf","Chapter 1: Introduction"]
[null,2,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter2.pdf","Chapter 2: Information for All Providers"]
[null,3,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter3.pdf","Chapter 3: Ambulance Services"]
[null,4,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter4.pdf","Chapter 4: Ambulance, Taxi, and Other Transportation Services"]
[null,5,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter5.pdf","Chapter 5: Audiology and Hearing Services"]
[null,6,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter6.pdf","Chapter 6: Biofeedback, Electrocardiograms (EKG), Electrodiagnostic services, & Extracorporeal Shockwave Therapy (ESWT)"]
[null,7,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter7.pdf","Chapter 7: Chiropractic Services"]
[null,8,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter8.pdf","Chapter 8: Dental Services"]
[null,9,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter9.pdf","Chapter 9: Durable Medical Equipment (DME)"]
[null,10,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter10.pdf","Chapter 10: Evaluation and Management (E/M) Services"]
[null,11,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter11.pdf","Chapter 11: Home Health Services"]
[null,12,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter12.pdf","Chapter 12: Impairment Rating Services"]
[null,13,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter13.pdf","Chapter 13: Independent Medical Exams (IME)"]
[null,14,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter14.pdf","Chapter 14: Language Access Services"]
[null,15,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter15.pdf","Chapter 15: Medical Testimony"]
[null,16,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter16.pdf","Chapter 16: Medication Administration and Injections"]
[null,17,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter17.pdf","Chapter 17: Mental Health Services"]
[null,18,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter18.pdf","Chapter 18: Modifications to Home and Vehicle"]
[null,19,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MARFSChapter19.pdf","Chapter 19: Naturopathic Physicians and Acupuncture Services"]
[null,20,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter20.pdf","Chapter 20: Nurse Case Management"]
[null,21,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter21.pdf","Chapter 21: Obesity Treatment"]
[null,22,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter22.pdf","Chapter 22: Other Services"]
[null,23,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter23.pdf","Chapter 23: Pathology and Laboratory Services"]
[null,24,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter24.pdf","Chapter 24: Pharmacy Services"]
[null,25,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter25.pdf","Chapter 25: Physical Medicine Services"]
[null,26,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter26.pdf","Chapter 26: Radiology Services"]
[null,27,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter27.pdf","Chapter 27: Reports and Forms"]
[null,28,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter28.pdf","Chapter 28: Supplies, Materials, and Bundled Services"]
[null,29,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter29.pdf","Chapter 29: Surgery Services"]
[null,30,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter30.pdf","Chapter 30: Vocational Services"]
[null,31,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter31.pdf","Chapter 31: Washington RBRVS Payment System"]
[null,32,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter32.pdf","Chapter 32: Ambulatory Surgery Centers (ASCs)"]
[null,33,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter33.pdf","Chapter 33: Brain Injury Rehabilitation Services"]
[null,34,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter34.pdf","Chapter 34: Chronic Pain Management"]
[null,35,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter35.pdf","Chapter 35: Hospitals"]
[null,36,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2021/2021MarfsChapter36.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"]