Exhibit #1 - Final	
For Hospital Inpatient Discharges Dates of Service on and After 1/1/2016	
MS-DRG 	MDC	TYPE	MS-DRG Title	Weights	Geometric mean LOS	Arithmetic mean LOS	
001	PRE	P	HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC	26.2466	29.400	38.8	
002	PRE	P	HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W/O MCC	14.6448	16.600	20.0	
003	PRE	P	ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.	17.6569	25.500	31.7	
004	PRE	P	TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.	10.9458	20.000	24.1	
005	PRE	P	LIVER TRANSPLANT W MCC OR INTESTINAL TRANSPLANT	10.7263	15.300	21.0	
006	PRE	P	LIVER TRANSPLANT W/O MCC	4.8330	7.900	8.8	
007	PRE	P	LUNG TRANSPLANT	9.7007	15.800	18.8	
008	PRE	P	SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT	5.4338	9.800	11.4	
010	PRE	P	PANCREAS TRANSPLANT	4.3039	8.100	9.5	
011	PRE	P	TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W MCC	4.7501	11.300	13.8	
012	PRE	P	TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W CC	3.4047	8.400	9.8	
013	PRE	P	TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES W/O CC/MCC	2.1906	5.800	6.6	
014	PRE	P	ALLOGENEIC BONE MARROW TRANSPLANT	11.5928	22.700	27.5	
016	PRE	P	AUTOLOGOUS BONE MARROW TRANSPLANT W CC/MCC	6.1746	17.800	19.2	
017	PRE	P	AUTOLOGOUS BONE MARROW TRANSPLANT W/O CC/MCC	4.3721	10.000	12.8	
020	01	P	INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W MCC	9.7571	13.600	16.8	
021	01	P	INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W CC	7.1549	12.300	13.7	
022	01	P	INTRACRANIAL VASCULAR PROCEDURES W PDX HEMORRHAGE W/O CC/MCC	4.9977	6.700	8.4	
023	01	P	CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W MCC OR CHEMO IMPLANT	5.3486	7.900	11.0	
024	01	P	CRANIO W MAJOR DEV IMPL/ACUTE COMPLEX CNS PDX W/O MCC	3.7976	4.200	5.9	
025	01	P	CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC	4.2965	7.200	9.3	
026	01	P	CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W CC	2.9958	4.600	6.1	
027	01	P	CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC	2.2835	2.400	3.1	
028	01	P	SPINAL PROCEDURES W MCC	5.3695	9.300	11.7	
029	01	P	SPINAL PROCEDURES W CC OR SPINAL NEUROSTIMULATORS	3.0548	4.800	6.2	
030	01	P	SPINAL PROCEDURES W/O CC/MCC	1.7982	2.600	3.3	
031	01	P	VENTRICULAR SHUNT PROCEDURES W MCC	3.7834	7.400	10.3	
032	01	P	VENTRICULAR SHUNT PROCEDURES W CC	2.0352	3.300	4.7	
033	01	P	VENTRICULAR SHUNT PROCEDURES W/O CC/MCC	1.5734	2.000	2.5	
034	01	P	CAROTID ARTERY STENT PROCEDURE W MCC	3.6851	4.800	7.1	
035	01	P	CAROTID ARTERY STENT PROCEDURE W CC	2.3048	2.100	3.2	
036	01	P	CAROTID ARTERY STENT PROCEDURE W/O CC/MCC	1.7180	1.300	1.5	
037	01	P	EXTRACRANIAL PROCEDURES W MCC	3.0888	5.300	7.8	
038	01	P	EXTRACRANIAL PROCEDURES W CC	1.5560	2.300	3.2	
039	01	P	EXTRACRANIAL PROCEDURES W/O CC/MCC	1.0609	1.300	1.6	
040	01	P	PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC	3.8044	8.200	10.8	
041	01	P	PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM	2.1354	4.700	6.0	
042	01	P	PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W/O CC/MCC	1.9242	2.700	3.5	
052	01	M	SPINAL DISORDERS & INJURIES W CC/MCC	1.4915	4.100	5.4	
053	01	M	SPINAL DISORDERS & INJURIES W/O CC/MCC	0.8625	2.800	3.4	
054	01	M	NERVOUS SYSTEM NEOPLASMS W MCC	1.3570	4.000	5.4	
055	01	M	NERVOUS SYSTEM NEOPLASMS W/O MCC	1.0401	3.000	4.1	
056	01	M	DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC	1.8513	5.200	7.2	
057	01	M	DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC	1.0716	3.700	5.0	
058	01	M	MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC	1.7198	5.500	7.3	
059	01	M	MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W CC	1.0134	3.700	4.5	
060	01	M	MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC	0.8130	3.100	3.7	
061	01	M	ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC	2.6843	5.400	7.1	
062	01	M	ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W CC	1.8918	3.900	4.6	
063	01	M	ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W/O CC/MCC	1.5238	2.900	3.2	
064	01	M	INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC	1.7326	4.500	6.1	
065	01	M	INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS	1.0593	3.300	4.1	
066	01	M	INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC	0.7574	2.400	2.8	
067	01	M	NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W MCC	1.4338	4.000	5.0	
068	01	M	NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC	0.8731	2.400	2.9	
069	01	M	TRANSIENT ISCHEMIA	0.7227	2.100	2.5	
070	01	M	NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC	1.6283	4.700	6.3	
071	01	M	NONSPECIFIC CEREBROVASCULAR DISORDERS W CC	1.0079	3.500	4.4	
072	01	M	NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC	0.7329	2.400	3.0	
073	01	M	CRANIAL & PERIPHERAL NERVE DISORDERS W MCC	1.3359	3.800	5.2	
074	01	M	CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC	0.9063	3.000	3.8	
075	01	M	VIRAL MENINGITIS W CC/MCC	1.6917	5.300	6.7	
076	01	M	VIRAL MENINGITIS W/O CC/MCC	0.8302	2.900	3.4	
077	01	M	HYPERTENSIVE ENCEPHALOPATHY W MCC	1.5448	4.400	5.6	
078	01	M	HYPERTENSIVE ENCEPHALOPATHY W CC	0.9676	3.100	3.9	
079	01	M	HYPERTENSIVE ENCEPHALOPATHY W/O CC/MCC	0.6862	2.300	2.8	
080	01	M	NONTRAUMATIC STUPOR & COMA W MCC	1.2159	3.700	5.1	
081	01	M	NONTRAUMATIC STUPOR & COMA W/O MCC	0.7651	2.700	3.5	
082	01	M	TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC	2.0170	3.400	5.8	
083	01	M	TRAUMATIC STUPOR & COMA, COMA >1 HR W CC	1.3006	3.300	4.3	
084	01	M	TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC	0.8469	2.100	2.6	
085	01	M	TRAUMATIC STUPOR & COMA, COMA <1 HR W MCC	2.0357	4.700	6.6	
086	01	M	TRAUMATIC STUPOR & COMA, COMA <1 HR W CC	1.1394	3.300	4.1	
087	01	M	TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC	0.7918	2.200	2.7	
088	01	M	CONCUSSION W MCC	1.3653	3.700	4.7	
089	01	M	CONCUSSION W CC	0.9759	2.800	3.4	
090	01	M	CONCUSSION W/O CC/MCC	0.7394	1.900	2.3	
091	01	M	OTHER DISORDERS OF NERVOUS SYSTEM W MCC	1.5880	4.200	5.8	
092	01	M	OTHER DISORDERS OF NERVOUS SYSTEM W CC	0.9075	3.100	3.8	
093	01	M	OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC	0.6981	2.200	2.7	
094	01	M	BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC	3.4429	8.200	10.7	
095	01	M	BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC	2.3282	5.700	7.2	
096	01	M	BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W/O CC/MCC	2.1855	4.800	5.7	
097	01	M	NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC	3.1221	8.100	10.6	
098	01	M	NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC	1.8410	5.700	7.3	
099	01	M	NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC	1.2570	4.100	5.0	
100	01	M	SEIZURES W MCC	1.5639	4.200	5.6	
101	01	M	SEIZURES W/O MCC	0.7942	2.600	3.3	
102	01	M	HEADACHES W MCC	1.0685	3.100	4.2	
103	01	M	HEADACHES W/O MCC	0.7199	2.300	2.9	
113	02	P	ORBITAL PROCEDURES W CC/MCC	2.0118	4.000	5.8	
114	02	P	ORBITAL PROCEDURES W/O CC/MCC	1.2094	2.400	2.9	
115	02	P	EXTRAOCULAR PROCEDURES EXCEPT ORBIT	1.3151	3.500	4.5	
116	02	P	INTRAOCULAR PROCEDURES W CC/MCC	1.5015	3.500	5.2	
117	02	P	INTRAOCULAR PROCEDURES W/O CC/MCC	0.8340	2.000	2.5	
121	02	M	ACUTE MAJOR EYE INFECTIONS W CC/MCC	0.9934	3.800	4.7	
122	02	M	ACUTE MAJOR EYE INFECTIONS W/O CC/MCC	0.5850	3.000	3.6	
123	02	M	NEUROLOGICAL EYE DISORDERS	0.7171	2.100	2.6	
124	02	M	OTHER DISORDERS OF THE EYE W MCC	1.2163	3.800	5.1	
125	02	M	OTHER DISORDERS OF THE EYE W/O MCC	0.7256	2.500	3.2	
129	03	P	MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE	2.2292	3.700	5.2	
130	03	P	MAJOR HEAD & NECK PROCEDURES W/O CC/MCC	1.3596	2.300	2.8	
131	03	P	CRANIAL/FACIAL PROCEDURES W CC/MCC	2.4094	4.300	6.0	
132	03	P	CRANIAL/FACIAL PROCEDURES W/O CC/MCC	1.4401	2.200	2.8	
133	03	P	OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W CC/MCC	1.8573	3.800	5.5	
134	03	P	OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC	1.0635	1.900	2.4	
135	03	P	SINUS & MASTOID PROCEDURES W CC/MCC	1.9100	4.100	5.6	
136	03	P	SINUS & MASTOID PROCEDURES W/O CC/MCC	1.1905	1.900	2.6	
137	03	P	MOUTH PROCEDURES W CC/MCC	1.4261	3.800	5.0	
138	03	P	MOUTH PROCEDURES W/O CC/MCC	0.8272	2.000	2.5	
139	03	P	SALIVARY GLAND PROCEDURES	0.9828	1.600	2.2	
146	03	M	EAR, NOSE, MOUTH & THROAT MALIGNANCY W MCC	1.8740	5.700	8.0	
147	03	M	EAR, NOSE, MOUTH & THROAT MALIGNANCY W CC	1.2419	3.900	5.2	
148	03	M	EAR, NOSE, MOUTH & THROAT MALIGNANCY W/O CC/MCC	0.8094	2.200	2.8	
149	03	M	DYSEQUILIBRIUM	0.6707	2.100	2.5	
150	03	M	EPISTAXIS W MCC	1.2560	3.600	4.7	
151	03	M	EPISTAXIS W/O MCC	0.7033	2.300	2.8	
152	03	M	OTITIS MEDIA & URI W MCC	1.0612	3.400	4.3	
153	03	M	OTITIS MEDIA & URI W/O MCC	0.7042	2.500	3.0	
154	03	M	OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC	1.4090	4.000	5.4	
155	03	M	OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC	0.8733	3.100	3.8	
156	03	M	OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC	0.6662	2.300	2.8	
157	03	M	DENTAL & ORAL DISEASES W MCC	1.4949	4.500	6.1	
158	03	M	DENTAL & ORAL DISEASES W CC	0.8582	3.000	3.8	
159	03	M	DENTAL & ORAL DISEASES W/O CC/MCC	0.6176	2.100	2.6	
163	04	P	MAJOR CHEST PROCEDURES W MCC	5.0016	10.500	12.8	
164	04	P	MAJOR CHEST PROCEDURES W CC	2.5822	5.300	6.4	
165	04	P	MAJOR CHEST PROCEDURES W/O CC/MCC	1.8148	3.100	3.8	
166	04	P	OTHER RESP SYSTEM O.R. PROCEDURES W MCC	3.6796	8.500	10.9	
167	04	P	OTHER RESP SYSTEM O.R. PROCEDURES W CC	1.9367	5.000	6.2	
168	04	P	OTHER RESP SYSTEM O.R. PROCEDURES W/O CC/MCC	1.2950	2.900	3.8	
175	04	M	PULMONARY EMBOLISM W MCC	1.4839	4.900	5.9	
176	04	M	PULMONARY EMBOLISM W/O MCC	0.9375	3.300	4.0	
177	04	M	RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC	1.9033	6.000	7.4	
178	04	M	RESPIRATORY INFECTIONS & INFLAMMATIONS W CC	1.3575	4.800	5.8	
179	04	M	RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC	0.9659	3.600	4.3	
180	04	M	RESPIRATORY NEOPLASMS W MCC	1.6767	5.200	6.7	
181	04	M	RESPIRATORY NEOPLASMS W CC	1.1775	3.700	4.8	
182	04	M	RESPIRATORY NEOPLASMS W/O CC/MCC	0.8553	2.600	3.3	
183	04	M	MAJOR CHEST TRAUMA W MCC	1.4723	4.700	5.8	
184	04	M	MAJOR CHEST TRAUMA W CC	1.0125	3.400	4.0	
185	04	M	MAJOR CHEST TRAUMA W/O CC/MCC	0.7182	2.500	2.9	
186	04	M	PLEURAL EFFUSION W MCC	1.5734	4.700	6.1	
187	04	M	PLEURAL EFFUSION W CC	1.0835	3.500	4.4	
188	04	M	PLEURAL EFFUSION W/O CC/MCC	0.7860	2.700	3.3	
189	04	M	PULMONARY EDEMA & RESPIRATORY FAILURE	1.2265	3.900	5.0	
190	04	M	CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC	1.1578	4.000	4.9	
191	04	M	CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC	0.9321	3.300	4.0	
192	04	M	CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC	0.7313	2.700	3.3	
193	04	M	SIMPLE PNEUMONIA & PLEURISY W MCC	1.4261	4.800	5.8	
194	04	M	SIMPLE PNEUMONIA & PLEURISY W CC	0.9695	3.700	4.4	
195	04	M	SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC	0.7111	2.800	3.3	
196	04	M	INTERSTITIAL LUNG DISEASE W MCC	1.6315	5.200	6.6	
197	04	M	INTERSTITIAL LUNG DISEASE W CC	1.0406	3.600	4.4	
198	04	M	INTERSTITIAL LUNG DISEASE W/O CC/MCC	0.7775	2.800	3.4	
199	04	M	PNEUMOTHORAX W MCC	1.7503	5.700	7.2	
200	04	M	PNEUMOTHORAX W CC	1.0443	3.500	4.5	
201	04	M	PNEUMOTHORAX W/O CC/MCC	0.7354	2.700	3.3	
202	04	M	BRONCHITIS & ASTHMA W CC/MCC	0.8980	3.100	3.8	
203	04	M	BRONCHITIS & ASTHMA W/O CC/MCC	0.6697	2.500	3.0	
204	04	M	RESPIRATORY SIGNS & SYMPTOMS	0.7291	2.200	2.8	
205	04	M	OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC	1.4478	4.100	5.4	
206	04	M	OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC	0.8164	2.500	3.2	
207	04	M	RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS	5.3498	12.200	14.1	
208	04	M	RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <96 HOURS	2.3055	4.900	6.7	
215	05	P	OTHER HEART ASSIST SYSTEM IMPLANT	15.8738	12.000	18.4	
216	05	P	CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W MCC	9.4642	12.700	15.5	
217	05	P	CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W CC	6.2576	8.500	9.7	
218	05	P	CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W CARD CATH W/O CC/MCC	5.4815	6.500	7.2	
219	05	P	CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W MCC	7.5590	9.600	11.5	
220	05	P	CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W CC	5.1074	6.500	7.1	
221	05	P	CARDIAC VALVE & OTH MAJ CARDIOTHORACIC PROC W/O CARD CATH W/O CC/MCC	4.5406	4.800	5.4	
222	05	P	CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W MCC	8.5188	10.200	12.1	
223	05	P	CARDIAC DEFIB IMPLANT W CARDIAC CATH W AMI/HF/SHOCK W/O MCC	6.4026	5.400	6.6	
224	05	P	CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W MCC	7.6140	8.000	9.9	
225	05	P	CARDIAC DEFIB IMPLANT W CARDIAC CATH W/O AMI/HF/SHOCK W/O MCC	5.8561	4.100	4.9	
226	05	P	CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W MCC	6.9737	6.800	8.9	
227	05	P	CARDIAC DEFIBRILLATOR IMPLANT W/O CARDIAC CATH W/O MCC	5.4816	3.100	4.3	
228	05	P	OTHER CARDIOTHORACIC PROCEDURES W MCC	6.9512	10.800	12.8	
229	05	P	OTHER CARDIOTHORACIC PROCEDURES W CC	4.5589	6.500	7.4	
230	05	P	OTHER CARDIOTHORACIC PROCEDURES W/O CC/MCC	4.3018	4.300	4.9	
231	05	P	CORONARY BYPASS W PTCA W MCC	7.8056	9.900	11.7	
232	05	P	CORONARY BYPASS W PTCA W/O MCC	5.7779	7.900	8.6	
233	05	P	CORONARY BYPASS W CARDIAC CATH W MCC	7.3581	11.600	13.0	
234	05	P	CORONARY BYPASS W CARDIAC CATH W/O MCC	4.9076	8.000	8.6	
235	05	P	CORONARY BYPASS W/O CARDIAC CATH W MCC	5.8103	8.900	10.3	
236	05	P	CORONARY BYPASS W/O CARDIAC CATH W/O MCC	3.8013	6.000	6.5	
239	05	P	AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC	4.8380	10.500	13.4	
240	05	P	AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC	2.6835	7.000	8.5	
241	05	P	AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W/O CC/MCC	1.4476	4.500	5.3	
242	05	P	PERMANENT CARDIAC PACEMAKER IMPLANT W MCC	3.7836	5.700	7.4	
243	05	P	PERMANENT CARDIAC PACEMAKER IMPLANT W CC	2.6444	3.600	4.4	
244	05	P	PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC	2.1394	2.500	2.9	
245	05	P	AICD GENERATOR PROCEDURES	4.6864	4.000	5.5	
246	05	P	PERC CARDIOVASC PROC W DRUG-ELUTING STENT W MCC OR 4+ VESSELS/STENTS	3.2494	4.100	5.5	
247	05	P	PERC CARDIOVASC PROC W DRUG-ELUTING STENT W/O MCC	2.1307	2.200	2.7	
248	05	P	PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W MCC OR 4+ VES/STENTS	3.0696	4.800	6.3	
249	05	P	PERC CARDIOVASC PROC W NON-DRUG-ELUTING STENT W/O MCC	1.9140	2.500	3.1	
250	05	P	PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W MCC	2.6975	4.200	5.7	
251	05	P	PERC CARDIOVASC PROC W/O CORONARY ARTERY STENT W/O MCC	1.6863	2.400	2.9	
252	05	P	OTHER VASCULAR PROCEDURES W MCC	3.2872	5.500	7.9	
253	05	P	OTHER VASCULAR PROCEDURES W CC	2.6028	4.300	5.7	
254	05	P	OTHER VASCULAR PROCEDURES W/O CC/MCC	1.7232	2.400	3.0	
255	05	P	UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC	2.6202	6.800	8.6	
256	05	P	UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC	1.6241	5.300	6.4	
257	05	P	UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC	1.0844	3.400	4.1	
258	05	P	CARDIAC PACEMAKER DEVICE REPLACEMENT W MCC	2.8590	4.900	6.3	
259	05	P	CARDIAC PACEMAKER DEVICE REPLACEMENT W/O MCC	1.9456	2.900	3.6	
260	05	P	CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W MCC	3.7299	7.600	10.3	
261	05	P	CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W CC	1.8639	3.500	4.4	
262	05	P	CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT W/O CC/MCC	1.5125	2.500	3.0	
263	05	P	VEIN LIGATION & STRIPPING	2.0854	4.100	6.2	
264	05	P	OTHER CIRCULATORY SYSTEM O.R. PROCEDURES	2.8080	5.800	8.3	
265	05	P	AICD LEAD PROCEDURES	2.9681	3.100	4.5	
266	05	P	ENDOVASCULAR CARDIAC VALVE REPLACEMENT W MCC	8.5986	7.300	9.5	
267	05	P	ENDOVASCULAR CARDIAC VALVE REPLACEMENT W/O MCC	6.5575	4.400	5.2	
268	05	P	AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W MCC	6.2807	6.900	9.9	
269	05	P	AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON W/O MCC	3.9041	1.900	2.6	
270	05	P	OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC	4.7349	6.500	9.3	
271	05	P	OTHER MAJOR CARDIOVASCULAR PROCEDURES W CC	3.1426	4.500	6.0	
272	05	P	OTHER MAJOR CARDIOVASCULAR PROCEDURES W/O CC/MCC	2.2508	2.300	3.1	
273	05	P	PERCUTANEOUS INTRACARDIAC PROCEDURES W MCC	3.5499	6.000	8.0	
274	05	P	PERCUTANEOUS INTRACARDIAC PROCEDURES W/O MCC	2.4197	2.700	3.4	
280	05	M	ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC	1.6971	4.500	5.8	
281	05	M	ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC	1.0232	2.900	3.6	
282	05	M	ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC	0.7557	2.000	2.4	
283	05	M	ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC	1.6613	2.900	4.6	
284	05	M	ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC	0.7827	1.800	2.5	
285	05	M	ACUTE MYOCARDIAL INFARCTION, EXPIRED W/O CC/MCC	0.5473	1.400	1.6	
286	05	M	CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC	2.1775	5.100	6.9	
287	05	M	CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC	1.1562	2.500	3.3	
288	05	M	ACUTE & SUBACUTE ENDOCARDITIS W MCC	2.7933	7.500	9.5	
289	05	M	ACUTE & SUBACUTE ENDOCARDITIS W CC	1.6969	5.600	6.9	
290	05	M	ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC	1.0546	3.700	4.4	
291	05	M	HEART FAILURE & SHOCK W MCC	1.4809	4.600	5.8	
292	05	M	HEART FAILURE & SHOCK W CC	0.9707	3.600	4.4	
293	05	M	HEART FAILURE & SHOCK W/O CC/MCC	0.6737	2.600	3.1	
294	05	M	DEEP VEIN THROMBOPHLEBITIS W CC/MCC	0.9826	3.800	4.7	
295	05	M	DEEP VEIN THROMBOPHLEBITIS W/O CC/MCC	0.7427	3.200	3.7	
296	05	M	CARDIAC ARREST, UNEXPLAINED W MCC	1.2864	1.900	2.8	
297	05	M	CARDIAC ARREST, UNEXPLAINED W CC	0.6488	1.300	1.6	
298	05	M	CARDIAC ARREST, UNEXPLAINED W/O CC/MCC	0.4477	1.100	1.2	
299	05	M	PERIPHERAL VASCULAR DISORDERS W MCC	1.4216	4.300	5.6	
300	05	M	PERIPHERAL VASCULAR DISORDERS W CC	0.9994	3.500	4.4	
301	05	M	PERIPHERAL VASCULAR DISORDERS W/O CC/MCC	0.7023	2.600	3.2	
302	05	M	ATHEROSCLEROSIS W MCC	1.0590	2.900	3.9	
303	05	M	ATHEROSCLEROSIS W/O MCC	0.6427	2.000	2.4	
304	05	M	HYPERTENSION W MCC	1.0109	3.300	4.1	
305	05	M	HYPERTENSION W/O MCC	0.6626	2.200	2.6	
306	05	M	CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC	1.4029	4.000	5.4	
307	05	M	CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC	0.8044	2.500	3.2	
308	05	M	CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC	1.2150	3.800	4.8	
309	05	M	CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC	0.7851	2.600	3.3	
310	05	M	CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC	0.5608	2.000	2.3	
311	05	M	ANGINA PECTORIS	0.6091	1.800	2.3	
312	05	M	SYNCOPE & COLLAPSE	0.7630	2.400	2.9	
313	05	M	CHEST PAIN	0.6621	1.800	2.2	
314	05	M	OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC	1.9334	4.900	6.7	
315	05	M	OTHER CIRCULATORY SYSTEM DIAGNOSES W CC	0.9722	3.100	3.9	
316	05	M	OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC	0.6498	2.000	2.5	
326	06	P	STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC	5.4452	11.000	14.2	
327	06	P	STOMACH, ESOPHAGEAL & DUODENAL PROC W CC	2.6399	5.700	7.5	
328	06	P	STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC	1.5154	2.500	3.3	
329	06	P	MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC	5.0709	11.500	14.2	
330	06	P	MAJOR SMALL & LARGE BOWEL PROCEDURES W CC	2.5511	7.000	8.2	
331	06	P	MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC	1.6491	4.100	4.6	
332	06	P	RECTAL RESECTION W MCC	4.5570	10.200	12.4	
333	06	P	RECTAL RESECTION W CC	2.4254	6.000	7.1	
334	06	P	RECTAL RESECTION W/O CC/MCC	1.6480	3.500	4.1	
335	06	P	PERITONEAL ADHESIOLYSIS W MCC	4.1261	10.400	12.6	
336	06	P	PERITONEAL ADHESIOLYSIS W CC	2.3340	6.700	8.1	
337	06	P	PERITONEAL ADHESIOLYSIS W/O CC/MCC	1.5675	4.000	4.9	
338	06	P	APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W MCC	2.9719	7.500	9.0	
339	06	P	APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC	1.7693	4.800	5.8	
340	06	P	APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC	1.1773	2.900	3.4	
341	06	P	APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC	2.1523	4.500	6.2	
342	06	P	APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC	1.3275	2.700	3.5	
343	06	P	APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC	1.0099	1.700	2.0	
344	06	P	MINOR SMALL & LARGE BOWEL PROCEDURES W MCC	3.1029	8.000	10.2	
345	06	P	MINOR SMALL & LARGE BOWEL PROCEDURES W CC	1.6268	5.200	6.1	
346	06	P	MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC	1.2143	3.700	4.2	
347	06	P	ANAL & STOMAL PROCEDURES W MCC	2.4457	6.100	8.3	
348	06	P	ANAL & STOMAL PROCEDURES W CC	1.4486	4.000	5.1	
349	06	P	ANAL & STOMAL PROCEDURES W/O CC/MCC	0.9265	2.400	2.9	
350	06	P	INGUINAL & FEMORAL HERNIA PROCEDURES W MCC	2.4982	5.600	7.6	
351	06	P	INGUINAL & FEMORAL HERNIA PROCEDURES W CC	1.4110	3.400	4.3	
352	06	P	INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC	0.9764	2.100	2.6	
353	06	P	HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W MCC	2.9142	6.200	8.1	
354	06	P	HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC	1.6640	3.900	4.8	
355	06	P	HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC	1.2366	2.500	3.0	
356	06	P	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC	3.7588	8.200	10.9	
357	06	P	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC	2.0801	5.100	6.6	
358	06	P	OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC	1.3515	3.100	3.8	
368	06	M	MAJOR ESOPHAGEAL DISORDERS W MCC	1.7848	4.800	6.1	
369	06	M	MAJOR ESOPHAGEAL DISORDERS W CC	1.0630	3.400	4.1	
370	06	M	MAJOR ESOPHAGEAL DISORDERS W/O CC/MCC	0.7355	2.400	2.9	
371	06	M	MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC	1.7854	5.800	7.5	
372	06	M	MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC	1.1090	4.400	5.4	
373	06	M	MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC	0.7817	3.300	3.9	
374	06	M	DIGESTIVE MALIGNANCY W MCC	2.0345	5.900	7.9	
375	06	M	DIGESTIVE MALIGNANCY W CC	1.2302	4.000	5.1	
376	06	M	DIGESTIVE MALIGNANCY W/O CC/MCC	0.9093	2.800	3.5	
377	06	M	G.I. HEMORRHAGE W MCC	1.7509	4.700	5.9	
378	06	M	G.I. HEMORRHAGE W CC	0.9949	3.200	3.8	
379	06	M	G.I. HEMORRHAGE W/O CC/MCC	0.6712	2.300	2.7	
380	06	M	COMPLICATED PEPTIC ULCER W MCC	1.9549	5.300	7.0	
381	06	M	COMPLICATED PEPTIC ULCER W CC	1.0690	3.500	4.2	
382	06	M	COMPLICATED PEPTIC ULCER W/O CC/MCC	0.8238	2.700	3.3	
383	06	M	UNCOMPLICATED PEPTIC ULCER W MCC	1.3545	4.200	5.1	
384	06	M	UNCOMPLICATED PEPTIC ULCER W/O MCC	0.8481	2.800	3.3	
385	06	M	INFLAMMATORY BOWEL DISEASE W MCC	1.7195	5.700	7.5	
386	06	M	INFLAMMATORY BOWEL DISEASE W CC	0.9996	3.800	4.8	
387	06	M	INFLAMMATORY BOWEL DISEASE W/O CC/MCC	0.7379	3.000	3.6	
388	06	M	G.I. OBSTRUCTION W MCC	1.5813	5.200	6.8	
389	06	M	G.I. OBSTRUCTION W CC	0.8707	3.500	4.3	
390	06	M	G.I. OBSTRUCTION W/O CC/MCC	0.6067	2.700	3.1	
391	06	M	ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC	1.1925	3.800	5.0	
392	06	M	ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC	0.7400	2.700	3.3	
393	06	M	OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC	1.6335	4.600	6.3	
394	06	M	OTHER DIGESTIVE SYSTEM DIAGNOSES W CC	0.9502	3.300	4.2	
395	06	M	OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC	0.6756	2.400	2.9	
405	07	P	PANCREAS, LIVER & SHUNT PROCEDURES W MCC	5.5888	10.500	14.2	
406	07	P	PANCREAS, LIVER & SHUNT PROCEDURES W CC	2.8075	5.900	7.4	
407	07	P	PANCREAS, LIVER & SHUNT PROCEDURES W/O CC/MCC	2.0026	4.100	5.0	
408	07	P	BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W MCC	3.6476	9.600	11.6	
409	07	P	BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W CC	2.4648	6.600	7.9	
410	07	P	BILIARY TRACT PROC EXCEPT ONLY CHOLECYST W OR W/O C.D.E. W/O CC/MCC	1.5576	4.500	5.2	
411	07	P	CHOLECYSTECTOMY W C.D.E. W MCC	3.5782	8.900	11.0	
412	07	P	CHOLECYSTECTOMY W C.D.E. W CC	2.4981	6.600	7.6	
413	07	P	CHOLECYSTECTOMY W C.D.E. W/O CC/MCC	1.7996	4.100	5.0	
414	07	P	CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W MCC	3.5283	8.500	10.3	
415	07	P	CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W CC	2.0071	5.500	6.4	
416	07	P	CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC	1.3342	3.400	4.0	
417	07	P	LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC	2.4734	5.800	7.2	
418	07	P	LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC	1.6584	3.900	4.7	
419	07	P	LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC	1.2540	2.500	3.0	
420	07	P	HEPATOBILIARY DIAGNOSTIC PROCEDURES W MCC	3.6609	8.100	11.1	
421	07	P	HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC	1.7451	4.100	5.3	
422	07	P	HEPATOBILIARY DIAGNOSTIC PROCEDURES W/O CC/MCC	1.2941	2.800	3.4	
423	07	P	OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W MCC	4.2650	9.800	13.4	
424	07	P	OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W CC	2.3049	6.000	8.0	
425	07	P	OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES W/O CC/MCC	1.6000	3.600	4.8	
432	07	M	CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC	1.6567	4.700	6.1	
433	07	M	CIRRHOSIS & ALCOHOLIC HEPATITIS W CC	0.9164	3.200	4.0	
434	07	M	CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC	0.6235	2.300	2.7	
435	07	M	MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC	1.7476	5.100	6.6	
436	07	M	MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC	1.1686	3.800	4.9	
437	07	M	MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W/O CC/MCC	0.9051	2.700	3.4	
438	07	M	DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC	1.6612	4.900	6.7	
439	07	M	DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC	0.8823	3.500	4.3	
440	07	M	DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC	0.6368	2.600	3.1	
441	07	M	DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC	1.8767	5.000	6.8	
442	07	M	DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC	0.9371	3.400	4.3	
443	07	M	DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC	0.6545	2.500	3.1	
444	07	M	DISORDERS OF THE BILIARY TRACT W MCC	1.5895	4.500	5.9	
445	07	M	DISORDERS OF THE BILIARY TRACT W CC	1.0553	3.300	4.0	
446	07	M	DISORDERS OF THE BILIARY TRACT W/O CC/MCC	0.7633	2.400	2.8	
453	08	P	COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W MCC	11.4304	9.200	11.3	
454	08	P	COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W CC	8.0698	4.900	5.8	
455	08	P	COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC/MCC	6.1934	3.000	3.4	
456	08	P	SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W MCC	9.4061	9.800	12.0	
457	08	P	SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W CC	7.0741	5.500	6.5	
458	08	P	SPINAL FUS EXC CERV W SPINAL CURV/MALIG/INFEC OR EXT FUS W/O CC/MCC	5.2986	3.300	3.7	
459	08	P	SPINAL FUSION EXCEPT CERVICAL W MCC	6.5455	6.700	8.3	
460	08	P	SPINAL FUSION EXCEPT CERVICAL W/O MCC	3.9717	2.900	3.4	
461	08	P	BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W MCC	5.0977	6.300	8.2	
462	08	P	BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY W/O MCC	3.2145	3.200	3.5	
463	08	P	WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC	5.1028	10.200	13.4	
464	08	P	WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W CC	3.0937	6.200	7.8	
465	08	P	WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W/O CC/MCC	1.9349	3.800	4.7	
466	08	P	REVISION OF HIP OR KNEE REPLACEMENT W MCC	5.0394	6.600	8.1	
467	08	P	REVISION OF HIP OR KNEE REPLACEMENT W CC	3.4376	3.700	4.3	
468	08	P	REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC	2.7513	2.700	3.0	
469	08	P	MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC	3.2962	5.900	7.0	
470	08	P	MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC	2.0816	2.800	3.1	
471	08	P	CERVICAL SPINAL FUSION W MCC	4.9033	6.200	8.6	
472	08	P	CERVICAL SPINAL FUSION W CC	2.9051	2.400	3.3	
473	08	P	CERVICAL SPINAL FUSION W/O CC/MCC	2.2650	1.500	1.8	
474	08	P	AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W MCC	3.6260	8.700	11.0	
475	08	P	AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W CC	2.1001	5.700	7.2	
476	08	P	AMPUTATION FOR MUSCULOSKELETAL SYS & CONN TISSUE DIS W/O CC/MCC	1.1427	3.100	3.9	
477	08	P	BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC	3.1211	8.300	10.2	
478	08	P	BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC	2.1992	5.400	6.6	
479	08	P	BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC	1.7158	3.500	4.3	
480	08	P	HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC	2.9990	6.700	7.9	
481	08	P	HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC	1.9790	4.600	5.0	
482	08	P	HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC	1.6228	3.700	4.0	
483	08	P	MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES	2.4127	1.900	2.3	
485	08	P	KNEE PROCEDURES W PDX OF INFECTION W MCC	3.2132	8.100	9.8	
486	08	P	KNEE PROCEDURES W PDX OF INFECTION W CC	2.0690	5.400	6.2	
487	08	P	KNEE PROCEDURES W PDX OF INFECTION W/O CC/MCC	1.5484	3.900	4.5	
488	08	P	KNEE PROCEDURES W/O PDX OF INFECTION W CC/MCC	1.7591	3.400	4.2	
489	08	P	KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC	1.2991	2.300	2.6	
492	08	P	LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W MCC	3.1585	6.200	7.6	
493	08	P	LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC	2.0557	3.900	4.6	
494	08	P	LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC	1.5796	2.700	3.1	
495	08	P	LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W MCC	3.0151	7.300	9.3	
496	08	P	LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W CC	1.7451	4.000	5.1	
497	08	P	LOCAL EXCISION & REMOVAL INT FIX DEVICES EXC HIP & FEMUR W/O CC/MCC	1.2436	2.100	2.6	
498	08	P	LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W CC/MCC	2.2492	5.400	7.3	
499	08	P	LOCAL EXCISION & REMOVAL INT FIX DEVICES OF HIP & FEMUR W/O CC/MCC	1.0512	2.200	2.7	
500	08	P	SOFT TISSUE PROCEDURES W MCC	3.2024	7.400	10.1	
501	08	P	SOFT TISSUE PROCEDURES W CC	1.6064	4.300	5.4	
502	08	P	SOFT TISSUE PROCEDURES W/O CC/MCC	1.1752	2.400	2.9	
503	08	P	FOOT PROCEDURES W MCC	2.2679	6.700	8.1	
504	08	P	FOOT PROCEDURES W CC	1.5941	5.000	5.9	
505	08	P	FOOT PROCEDURES W/O CC/MCC	1.2590	2.900	3.5	
506	08	P	MAJOR THUMB OR JOINT PROCEDURES	1.3490	3.400	4.3	
507	08	P	MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W CC/MCC	1.8698	4.300	5.3	
508	08	P	MAJOR SHOULDER OR ELBOW JOINT PROCEDURES W/O CC/MCC	1.6134	2.200	2.7	
509	08	P	ARTHROSCOPY	1.6562	3.400	4.8	
510	08	P	SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W MCC	2.4420	4.800	5.9	
511	08	P	SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC	1.7018	3.300	3.9	
512	08	P	SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W/O CC/MCC	1.3531	2.100	2.5	
513	08	P	HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC	1.5025	3.800	4.9	
514	08	P	HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W/O CC/MCC	0.9055	2.300	2.8	
515	08	P	OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC	3.1862	7.000	8.9	
516	08	P	OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC	2.0670	4.300	5.3	
517	08	P	OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC	1.7716	2.600	3.2	
518	08	P	BACK & NECK PROC EXC SPINAL FUSION W MCC OR DISC DEVICE/NEUROSTIM	2.9249	3.800	5.8	
519	08	P	BACK & NECK PROC EXC SPINAL FUSION W CC	1.6805	3.100	4.0	
520	08	P	BACK & NECK PROC EXC SPINAL FUSION W/O CC/MCC	1.1812	1.900	2.3	
533	08	M	FRACTURES OF FEMUR W MCC	1.4430	4.500	6.0	
534	08	M	FRACTURES OF FEMUR W/O MCC	0.7353	2.900	3.5	
535	08	M	FRACTURES OF HIP & PELVIS W MCC	1.2235	4.000	5.1	
536	08	M	FRACTURES OF HIP & PELVIS W/O MCC	0.7241	3.000	3.4	
537	08	M	SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W CC/MCC	0.9046	3.300	3.9	
538	08	M	SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC	0.6282	2.500	2.9	
539	08	M	OSTEOMYELITIS W MCC	1.8365	6.000	7.8	
540	08	M	OSTEOMYELITIS W CC	1.2832	4.700	5.9	
541	08	M	OSTEOMYELITIS W/O CC/MCC	0.9098	3.400	4.3	
542	08	M	PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC	1.9100	5.700	7.5	
543	08	M	PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC	1.1171	4.000	5.0	
544	08	M	PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC	0.7805	3.100	3.5	
545	08	M	CONNECTIVE TISSUE DISORDERS W MCC	2.4409	5.900	8.3	
546	08	M	CONNECTIVE TISSUE DISORDERS W CC	1.1645	3.800	4.8	
547	08	M	CONNECTIVE TISSUE DISORDERS W/O CC/MCC	0.7882	2.700	3.3	
548	08	M	SEPTIC ARTHRITIS W MCC	1.8733	6.000	7.4	
549	08	M	SEPTIC ARTHRITIS W CC	1.1824	4.200	5.3	
550	08	M	SEPTIC ARTHRITIS W/O CC/MCC	0.8129	2.900	3.6	
551	08	M	MEDICAL BACK PROBLEMS W MCC	1.5573	4.600	5.9	
552	08	M	MEDICAL BACK PROBLEMS W/O MCC	0.8648	3.100	3.7	
553	08	M	BONE DISEASES & ARTHROPATHIES W MCC	1.2287	4.100	5.3	
554	08	M	BONE DISEASES & ARTHROPATHIES W/O MCC	0.7337	2.800	3.4	
555	08	M	SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W MCC	1.2656	3.700	5.0	
556	08	M	SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC	0.7440	2.600	3.2	
557	08	M	TENDONITIS, MYOSITIS & BURSITIS W MCC	1.4295	4.800	6.0	
558	08	M	TENDONITIS, MYOSITIS & BURSITIS W/O MCC	0.8457	3.300	3.9	
559	08	M	AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC	1.9202	5.000	7.0	
560	08	M	AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC	1.0814	3.500	4.4	
561	08	M	AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC	0.6842	2.100	2.6	
562	08	M	FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC	1.3662	4.200	5.3	
563	08	M	FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC	0.7870	3.000	3.5	
564	08	M	OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC	1.5225	4.700	6.1	
565	08	M	OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC	0.9598	3.500	4.3	
566	08	M	OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC	0.7159	2.500	3.1	
570	09	P	SKIN DEBRIDEMENT W MCC	2.4504	7.000	9.2	
571	09	P	SKIN DEBRIDEMENT W CC	1.4569	5.200	6.3	
572	09	P	SKIN DEBRIDEMENT W/O CC/MCC	1.0391	3.700	4.5	
573	09	P	SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W MCC	3.9130	8.600	12.9	
574	09	P	SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W CC	2.8430	7.400	9.5	
575	09	P	SKIN GRAFT FOR SKIN ULCER OR CELLULITIS W/O CC/MCC	1.6141	4.400	5.6	
576	09	P	SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W MCC	5.3493	8.900	13.6	
577	09	P	SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W CC	2.2579	4.400	6.4	
578	09	P	SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W/O CC/MCC	1.3812	2.600	3.7	
579	09	P	OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC	2.6848	7.000	9.1	
580	09	P	OTHER SKIN, SUBCUT TISS & BREAST PROC W CC	1.6155	4.000	5.3	
581	09	P	OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC	1.1834	2.200	2.8	
582	09	P	MASTECTOMY FOR MALIGNANCY W CC/MCC	1.3370	2.200	2.9	
583	09	P	MASTECTOMY FOR MALIGNANCY W/O CC/MCC	1.1856	1.600	1.9	
584	09	P	BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W CC/MCC	1.6794	3.700	5.0	
585	09	P	BREAST BIOPSY, LOCAL EXCISION & OTHER BREAST PROCEDURES W/O CC/MCC	1.5184	2.100	2.5	
592	09	M	SKIN ULCERS W MCC	1.4255	5.000	6.4	
593	09	M	SKIN ULCERS W CC	1.0198	4.200	5.1	
594	09	M	SKIN ULCERS W/O CC/MCC	0.7049	3.100	3.7	
595	09	M	MAJOR SKIN DISORDERS W MCC	1.8480	5.400	7.3	
596	09	M	MAJOR SKIN DISORDERS W/O MCC	0.9375	3.600	4.4	
597	09	M	MALIGNANT BREAST DISORDERS W MCC	1.7397	5.300	7.0	
598	09	M	MALIGNANT BREAST DISORDERS W CC	1.0617	3.700	4.7	
599	09	M	MALIGNANT BREAST DISORDERS W/O CC/MCC	0.7211	2.300	3.0	
600	09	M	NON-MALIGNANT BREAST DISORDERS W CC/MCC	0.9843	3.700	4.6	
601	09	M	NON-MALIGNANT BREAST DISORDERS W/O CC/MCC	0.6799	2.800	3.3	
602	09	M	CELLULITIS W MCC	1.4371	4.900	6.1	
603	09	M	CELLULITIS W/O MCC	0.8429	3.500	4.1	
604	09	M	TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W MCC	1.3527	3.900	5.1	
605	09	M	TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC	0.8019	2.600	3.2	
606	09	M	MINOR SKIN DISORDERS W MCC	1.3708	4.300	5.9	
607	09	M	MINOR SKIN DISORDERS W/O MCC	0.7258	2.800	3.6	
614	10	P	ADRENAL & PITUITARY PROCEDURES W CC/MCC	2.3916	3.900	5.4	
615	10	P	ADRENAL & PITUITARY PROCEDURES W/O CC/MCC	1.4254	2.100	2.5	
616	10	P	AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W MCC	4.0054	10.300	12.6	
617	10	P	AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W CC	2.0064	6.000	7.2	
618	10	P	AMPUTAT OF LOWER LIMB FOR ENDOCRINE,NUTRIT,& METABOL DIS W/O CC/MCC	1.1804	4.300	5.0	
619	10	P	O.R. PROCEDURES FOR OBESITY W MCC	2.9418	3.800	5.7	
620	10	P	O.R. PROCEDURES FOR OBESITY W CC	1.8407	2.500	3.0	
621	10	P	O.R. PROCEDURES FOR OBESITY W/O CC/MCC	1.5484	1.800	1.9	
622	10	P	SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC	3.5239	8.600	11.5	
623	10	P	SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC	1.8623	5.600	6.8	
624	10	P	SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W/O CC/MCC	1.1292	3.700	4.5	
625	10	P	THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W MCC	2.6133	4.900	7.5	
626	10	P	THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W CC	1.3936	2.200	3.2	
627	10	P	THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES W/O CC/MCC	0.9108	1.300	1.5	
628	10	P	OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W MCC	3.4413	7.000	9.8	
629	10	P	OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W CC	2.1952	6.100	7.2	
630	10	P	OTHER ENDOCRINE, NUTRIT & METAB O.R. PROC W/O CC/MCC	1.3601	3.000	3.9	
637	10	M	DIABETES W MCC	1.3823	4.100	5.3	
638	10	M	DIABETES W CC	0.8463	3.000	3.7	
639	10	M	DIABETES W/O CC/MCC	0.6007	2.200	2.6	
640	10	M	MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC	1.1318	3.300	4.5	
641	10	M	MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC	0.7221	2.700	3.3	
642	10	M	INBORN AND OTHER DISORDERS OF METABOLISM	1.2246	3.400	4.5	
643	10	M	ENDOCRINE DISORDERS W MCC	1.6249	5.300	6.7	
644	10	M	ENDOCRINE DISORDERS W CC	1.0123	3.700	4.6	
645	10	M	ENDOCRINE DISORDERS W/O CC/MCC	0.7255	2.800	3.4	
652	11	P	KIDNEY TRANSPLANT	3.1540	5.500	6.5	
653	11	P	MAJOR BLADDER PROCEDURES W MCC	6.0456	11.900	14.8	
654	11	P	MAJOR BLADDER PROCEDURES W CC	3.0267	7.200	8.2	
655	11	P	MAJOR BLADDER PROCEDURES W/O CC/MCC	2.2796	4.800	5.4	
656	11	P	KIDNEY & URETER PROCEDURES FOR NEOPLASM W MCC	3.4617	6.800	8.8	
657	11	P	KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC	2.0091	4.200	5.0	
658	11	P	KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC	1.5337	2.600	3.0	
659	11	P	KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC	3.4848	7.500	10.1	
660	11	P	KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC	1.9030	4.100	5.5	
661	11	P	KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC	1.3981	2.300	2.7	
662	11	P	MINOR BLADDER PROCEDURES W MCC	2.8897	7.600	10.0	
663	11	P	MINOR BLADDER PROCEDURES W CC	1.6652	4.100	5.4	
664	11	P	MINOR BLADDER PROCEDURES W/O CC/MCC	1.2987	2.000	2.5	
665	11	P	PROSTATECTOMY W MCC	3.1132	8.900	11.2	
666	11	P	PROSTATECTOMY W CC	1.7878	4.600	6.3	
667	11	P	PROSTATECTOMY W/O CC/MCC	0.9964	2.300	3.0	
668	11	P	TRANSURETHRAL PROCEDURES W MCC	2.4521	6.300	8.4	
669	11	P	TRANSURETHRAL PROCEDURES W CC	1.3111	3.100	4.1	
670	11	P	TRANSURETHRAL PROCEDURES W/O CC/MCC	0.9207	2.100	2.6	
671	11	P	URETHRAL PROCEDURES W CC/MCC	1.5705	4.100	5.4	
672	11	P	URETHRAL PROCEDURES W/O CC/MCC	0.8742	1.900	2.4	
673	11	P	OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC	3.3559	7.300	10.3	
674	11	P	OTHER KIDNEY & URINARY TRACT PROCEDURES W CC	2.3148	5.400	7.1	
675	11	P	OTHER KIDNEY & URINARY TRACT PROCEDURES W/O CC/MCC	1.5595	2.400	3.2	
682	11	M	RENAL FAILURE W MCC	1.5085	4.600	6.0	
683	11	M	RENAL FAILURE W CC	0.9406	3.500	4.3	
684	11	M	RENAL FAILURE W/O CC/MCC	0.6272	2.500	2.9	
685	11	M	ADMIT FOR RENAL DIALYSIS	1.0369	2.900	3.8	
686	11	M	KIDNEY & URINARY TRACT NEOPLASMS W MCC	1.6670	5.300	7.0	
687	11	M	KIDNEY & URINARY TRACT NEOPLASMS W CC	1.0161	3.500	4.4	
688	11	M	KIDNEY & URINARY TRACT NEOPLASMS W/O CC/MCC	0.6607	2.200	2.8	
689	11	M	KIDNEY & URINARY TRACT INFECTIONS W MCC	1.0821	4.000	5.0	
690	11	M	KIDNEY & URINARY TRACT INFECTIONS W/O MCC	0.7828	3.100	3.7	
691	11	M	URINARY STONES W ESW LITHOTRIPSY W CC/MCC	1.5470	2.800	3.7	
692	11	M	URINARY STONES W ESW LITHOTRIPSY W/O CC/MCC	1.2566	1.900	2.3	
693	11	M	URINARY STONES W/O ESW LITHOTRIPSY W MCC	1.3323	3.800	4.9	
694	11	M	URINARY STONES W/O ESW LITHOTRIPSY W/O MCC	0.7294	2.000	2.5	
695	11	M	KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W MCC	1.2494	4.100	5.2	
696	11	M	KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC	0.6934	2.600	3.2	
697	11	M	URETHRAL STRICTURE	0.9417	2.800	3.6	
698	11	M	OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC	1.5524	5.000	6.3	
699	11	M	OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC	1.0246	3.500	4.4	
700	11	M	OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC	0.7163	2.600	3.2	
707	12	P	MAJOR MALE PELVIC PROCEDURES W CC/MCC	1.7753	2.800	3.8	
708	12	P	MAJOR MALE PELVIC PROCEDURES W/O CC/MCC	1.3146	1.400	1.6	
709	12	P	PENIS PROCEDURES W CC/MCC	1.9721	4.000	5.9	
710	12	P	PENIS PROCEDURES W/O CC/MCC	1.4170	1.800	2.4	
711	12	P	TESTES PROCEDURES W CC/MCC	1.9959	5.200	7.3	
712	12	P	TESTES PROCEDURES W/O CC/MCC	0.9475	2.300	3.0	
713	12	P	TRANSURETHRAL PROSTATECTOMY W CC/MCC	1.5077	3.400	4.7	
714	12	P	TRANSURETHRAL PROSTATECTOMY W/O CC/MCC	0.8072	1.700	2.0	
715	12	P	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W CC/MCC	1.8793	5.200	7.0	
716	12	P	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC FOR MALIGNANCY W/O CC/MCC	1.1508	1.600	2.0	
717	12	P	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC	1.7645	4.700	6.3	
718	12	P	OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC	0.9069	2.100	2.5	
722	12	M	MALIGNANCY, MALE REPRODUCTIVE SYSTEM W MCC	1.7370	5.500	7.3	
723	12	M	MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC	1.0979	3.800	4.8	
724	12	M	MALIGNANCY, MALE REPRODUCTIVE SYSTEM W/O CC/MCC	0.6545	2.000	2.9	
725	12	M	BENIGN PROSTATIC HYPERTROPHY W MCC	1.3198	4.500	5.8	
726	12	M	BENIGN PROSTATIC HYPERTROPHY W/O MCC	0.7406	2.700	3.3	
727	12	M	INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC	1.4461	4.900	6.2	
728	12	M	INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC	0.7838	3.100	3.8	
729	12	M	OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC	1.1169	3.500	4.6	
730	12	M	OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W/O CC/MCC	0.6036	2.300	2.9	
734	13	P	PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W CC/MCC	2.5255	4.500	6.4	
735	13	P	PELVIC EVISCERATION, RAD HYSTERECTOMY & RAD VULVECTOMY W/O CC/MCC	1.2207	1.800	2.2	
736	13	P	UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W MCC	4.3286	9.900	12.3	
737	13	P	UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC	2.0037	5.100	5.9	
738	13	P	UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W/O CC/MCC	1.3498	3.000	3.4	
739	13	P	UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W MCC	3.4082	6.600	9.0	
740	13	P	UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC	1.6920	3.300	4.2	
741	13	P	UTERINE,ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC	1.1973	1.800	2.2	
742	13	P	UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC	1.5586	3.000	4.0	
743	13	P	UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC	1.0090	1.800	2.0	
744	13	P	D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC	1.6851	4.100	5.8	
745	13	P	D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC	0.9719	2.000	2.4	
746	13	P	VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC	1.4628	3.300	4.8	
747	13	P	VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC	0.9099	1.600	1.9	
748	13	P	FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES	1.1241	1.600	2.0	
749	13	P	OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W CC/MCC	2.6452	6.100	8.5	
750	13	P	OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES W/O CC/MCC	1.3346	2.400	3.1	
754	13	M	MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC	1.9204	5.800	7.9	
755	13	M	MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W CC	1.1325	3.700	4.9	
756	13	M	MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC	0.5908	2.200	2.8	
757	13	M	INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC	1.3717	5.200	6.4	
758	13	M	INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC	1.0090	4.100	5.0	
759	13	M	INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC	0.7595	3.200	3.8	
760	13	M	MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC	0.8524	2.800	3.6	
761	13	M	MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W/O CC/MCC	0.5355	1.900	2.2	
765	14	P	CESAREAN SECTION W CC/MCC	1.1442	3.700	4.7	
766	14	P	CESAREAN SECTION W/O CC/MCC	0.7807	2.800	3.0	
767	14	P	VAGINAL DELIVERY W STERILIZATION &/OR D&C	1.2965	2.700	3.8	
768	14	P	VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C	1.2618	3.600	4.3	
769	14	P	POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE	2.1737	4.400	6.5	
770	14	P	ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY	0.8272	1.900	2.4	
774	14	M	VAGINAL DELIVERY W COMPLICATING DIAGNOSES	0.7509	2.600	3.1	
775	14	M	VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES	0.5865	2.100	2.3	
776	14	M	POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE	0.6766	2.400	3.2	
777	14	M	ECTOPIC PREGNANCY	0.9386	1.900	2.3	
778	14	M	THREATENED ABORTION	0.5332	2.000	3.1	
779	14	M	ABORTION W/O D&C	0.6850	1.700	2.2	
780	14	M	FALSE LABOR	0.2062	1.100	1.1	
781	14	M	OTHER ANTEPARTUM DIAGNOSES W MEDICAL COMPLICATIONS	0.8182	2.700	4.0	
782	14	M	OTHER ANTEPARTUM DIAGNOSES W/O MEDICAL COMPLICATIONS	0.5454	1.700	2.5	
789	15	M	NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY	1.5860	1.800	1.8	
790	15	M	EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE	5.2300	17.900	17.9	
791	15	M	PREMATURITY W MAJOR PROBLEMS	3.5719	13.300	13.3	
792	15	M	PREMATURITY W/O MAJOR PROBLEMS	2.1552	8.600	8.6	
793	15	M	FULL TERM NEONATE W MAJOR PROBLEMS	3.6692	4.700	4.7	
794	15	M	NEONATE W OTHER SIGNIFICANT PROBLEMS	1.2987	3.400	3.4	
795	15	M	NORMAL NEWBORN	0.1758	3.100	3.1	
799	16	P	SPLENECTOMY W MCC	4.7569	9.200	11.6	
800	16	P	SPLENECTOMY W CC	2.7364	5.300	6.8	
801	16	P	SPLENECTOMY W/O CC/MCC	1.7458	2.800	3.7	
802	16	P	OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W MCC	3.3880	8.100	11.1	
803	16	P	OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W CC	1.8719	4.700	6.0	
804	16	P	OTHER O.R. PROC OF THE BLOOD & BLOOD FORMING ORGANS W/O CC/MCC	1.1715	2.300	3.0	
808	16	M	MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC	2.2346	6.000	8.0	
809	16	M	MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC	1.2235	3.800	4.7	
810	16	M	MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W/O CC/MCC	0.8644	2.700	3.3	
811	16	M	RED BLOOD CELL DISORDERS W MCC	1.2992	3.700	4.9	
812	16	M	RED BLOOD CELL DISORDERS W/O MCC	0.8572	2.800	3.5	
813	16	M	COAGULATION DISORDERS	1.7350	3.700	5.1	
814	16	M	RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC	1.6622	4.700	6.4	
815	16	M	RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC	0.9803	3.200	4.1	
816	16	M	RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC/MCC	0.6962	2.400	2.9	
820	17	P	LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W MCC	5.9153	12.100	16.2	
821	17	P	LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W CC	2.3113	4.700	6.5	
822	17	P	LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC	1.2851	2.100	2.7	
823	17	P	LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W MCC	4.4536	11.100	14.3	
824	17	P	LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W CC	2.3467	6.000	7.9	
825	17	P	LYMPHOMA & NON-ACUTE LEUKEMIA W OTHER O.R. PROC W/O CC/MCC	1.3967	2.900	3.9	
826	17	P	MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W MCC	5.1814	10.800	14.3	
827	17	P	MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W CC	2.3141	5.000	6.5	
828	17	P	MYELOPROLIF DISORD OR POORLY DIFF NEOPL W MAJ O.R. PROC W/O CC/MCC	1.5139	2.800	3.5	
829	17	P	MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W CC/MCC	3.3241	6.800	10.2	
830	17	P	MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W/O CC/MCC	1.3670	2.600	3.5	
834	17	M	ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC	5.5990	10.400	17.2	
835	17	M	ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W CC	2.3024	4.900	7.7	
836	17	M	ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W/O CC/MCC	1.1381	2.900	4.0	
837	17	M	CHEMO W ACUTE LEUKEMIA AS SDX OR W HIGH DOSE CHEMO AGENT W MCC	6.1348	15.700	21.6	
838	17	M	CHEMO W ACUTE LEUKEMIA AS SDX W CC OR HIGH DOSE CHEMO AGENT	2.7707	7.000	9.8	
839	17	M	CHEMO W ACUTE LEUKEMIA AS SDX W/O CC/MCC	1.3190	4.900	5.5	
840	17	M	LYMPHOMA & NON-ACUTE LEUKEMIA W MCC	3.1449	7.600	10.4	
841	17	M	LYMPHOMA & NON-ACUTE LEUKEMIA W CC	1.6118	4.700	6.6	
842	17	M	LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC	1.1167	3.100	4.0	
843	17	M	OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC	1.8464	5.600	7.6	
844	17	M	OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC	1.1233	4.000	5.1	
845	17	M	OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W/O CC/MCC	0.8261	2.800	3.6	
846	17	M	CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W MCC	2.4618	5.900	8.0	
847	17	M	CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W CC	1.1883	3.400	3.9	
848	17	M	CHEMOTHERAPY W/O ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS W/O CC/MCC	0.9352	2.800	3.3	
849	17	M	RADIOTHERAPY	1.6745	4.900	6.5	
853	18	P	INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC	5.1334	10.700	13.7	
854	18	P	INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC	2.3804	6.600	7.9	
855	18	P	INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC	1.5124	3.500	4.7	
856	18	P	POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC	4.6569	9.800	12.8	
857	18	P	POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC	2.0516	5.600	7.0	
858	18	P	POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W/O CC/MCC	1.3300	3.800	4.5	
862	18	M	POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC	1.8550	5.500	7.1	
863	18	M	POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC	1.0089	3.700	4.5	
864	18	M	FEVER	0.8481	2.800	3.5	
865	18	M	VIRAL ILLNESS W MCC	1.5273	4.200	5.9	
866	18	M	VIRAL ILLNESS W/O MCC	0.7739	2.800	3.4	
867	18	M	OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W MCC	2.6068	6.700	9.0	
868	18	M	OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC	1.0292	3.800	4.7	
869	18	M	OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W/O CC/MCC	0.7091	2.800	3.4	
870	18	M	SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS	5.8782	12.600	14.6	
871	18	M	SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC	1.7926	5.000	6.5	
872	18	M	SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC	1.0427	3.900	4.6	
876	19	P	O.R. PROCEDURE W PRINCIPAL DIAGNOSES OF MENTAL ILLNESS	3.0841	7.800	13.5	
880	19	M	ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION	0.7227	2.400	3.3	
881	19	M	DEPRESSIVE NEUROSES	0.6618	3.400	4.5	
882	19	M	NEUROSES EXCEPT DEPRESSIVE	0.6924	3.300	4.5	
883	19	M	DISORDERS OF PERSONALITY & IMPULSE CONTROL	1.3737	4.600	8.0	
884	19	M	ORGANIC DISTURBANCES & MENTAL RETARDATION	1.1483	4.300	6.3	
885	19	M	PSYCHOSES	1.0575	5.600	7.7	
886	19	M	BEHAVIORAL & DEVELOPMENTAL DISORDERS	0.8718	3.900	6.0	
887	19	M	OTHER MENTAL DISORDER DIAGNOSES	0.9939	3.000	4.6	
894	20	M	ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA	0.4859	2.100	3.1	
895	20	M	ALCOHOL/DRUG ABUSE OR DEPENDENCE W REHABILITATION THERAPY	1.2435	9.300	12.0	
896	20	M	ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC	1.5678	4.800	6.6	
897	20	M	ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC	0.7231	3.300	4.1	
901	21	P	WOUND DEBRIDEMENTS FOR INJURIES W MCC	3.9370	9.200	13.3	
902	21	P	WOUND DEBRIDEMENTS FOR INJURIES W CC	1.8265	5.300	7.1	
903	21	P	WOUND DEBRIDEMENTS FOR INJURIES W/O CC/MCC	1.1723	3.300	4.3	
904	21	P	SKIN GRAFTS FOR INJURIES W CC/MCC	3.2140	7.100	10.4	
905	21	P	SKIN GRAFTS FOR INJURIES W/O CC/MCC	1.4233	3.600	4.7	
906	21	P	HAND PROCEDURES FOR INJURIES	1.5670	2.800	4.4	
907	21	P	OTHER O.R. PROCEDURES FOR INJURIES W MCC	3.8073	7.500	10.3	
908	21	P	OTHER O.R. PROCEDURES FOR INJURIES W CC	1.9904	4.300	5.7	
909	21	P	OTHER O.R. PROCEDURES FOR INJURIES W/O CC/MCC	1.2992	2.600	3.3	
913	21	M	TRAUMATIC INJURY W MCC	1.3561	3.800	5.1	
914	21	M	TRAUMATIC INJURY W/O MCC	0.7317	2.500	3.1	
915	21	M	ALLERGIC REACTIONS W MCC	1.6040	3.700	5.1	
916	21	M	ALLERGIC REACTIONS W/O MCC	0.5582	1.800	2.2	
917	21	M	POISONING & TOXIC EFFECTS OF DRUGS W MCC	1.4065	3.500	4.8	
918	21	M	POISONING & TOXIC EFFECTS OF DRUGS W/O MCC	0.6859	2.200	2.9	
919	21	M	COMPLICATIONS OF TREATMENT W MCC	1.7611	4.500	6.2	
920	21	M	COMPLICATIONS OF TREATMENT W CC	0.9991	3.100	4.0	
921	21	M	COMPLICATIONS OF TREATMENT W/O CC/MCC	0.6960	2.300	2.8	
922	21	M	OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC	1.5833	4.000	6.0	
923	21	M	OTHER INJURY, POISONING & TOXIC EFFECT DIAG W/O MCC	0.8117	2.500	3.5	
927	22	P	EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W SKIN GRAFT	15.9672	23.500	30.6	
928	22	P	FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC	5.7399	11.300	15.4	
929	22	P	FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W/O CC/MCC	2.4661	5.500	7.5	
933	22	M	EXTENSIVE BURNS OR FULL THICKNESS BURNS W MV >96 HRS W/O SKIN GRAFT	2.8685	2.600	5.9	
934	22	M	FULL THICKNESS BURN W/O SKIN GRFT OR INHAL INJ	1.6716	4.200	6.2	
935	22	M	NON-EXTENSIVE BURNS	1.5141	3.400	5.1	
939	23	P	O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC	2.9866	6.200	9.1	
940	23	P	O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC	1.9107	3.700	5.2	
941	23	P	O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC	1.3589	2.100	2.7	
945	23	M	REHABILITATION W CC/MCC	1.2781	8.800	10.9	
946	23	M	REHABILITATION W/O CC/MCC	1.0151	6.800	7.8	
947	23	M	SIGNS & SYMPTOMS W MCC	1.1323	3.500	4.7	
948	23	M	SIGNS & SYMPTOMS W/O MCC	0.7356	2.700	3.3	
949	23	M	AFTERCARE W CC/MCC	1.1197	3.300	5.1	
950	23	M	AFTERCARE W/O CC/MCC	0.5798	2.300	2.9	
951	23	M	OTHER FACTORS INFLUENCING HEALTH STATUS	0.9885	2.700	6.0	
955	24	P	CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA	5.6773	8.400	11.9	
956	24	P	LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA	3.7116	6.400	7.8	
957	24	P	OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC	6.5504	9.400	13.3	
958	24	P	OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W CC	3.8565	6.900	8.4	
959	24	P	OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC	2.1705	4.200	4.8	
963	24	M	OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC	2.6295	5.400	8.0	
964	24	M	OTHER MULTIPLE SIGNIFICANT TRAUMA W CC	1.4205	4.100	5.0	
965	24	M	OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC	0.9217	3.000	3.5	
969	25	P	HIV W EXTENSIVE O.R. PROCEDURE W MCC	5.0291	11.200	15.1	
970	25	P	HIV W EXTENSIVE O.R. PROCEDURE W/O MCC	2.7871	5.100	6.9	
974	25	M	HIV W MAJOR RELATED CONDITION W MCC	2.6531	6.600	9.2	
975	25	M	HIV W MAJOR RELATED CONDITION W CC	1.3589	4.500	6.0	
976	25	M	HIV W MAJOR RELATED CONDITION W/O CC/MCC	0.9073	3.300	4.1	
977	25	M	HIV W OR W/O OTHER RELATED CONDITION	1.1577	3.500	4.7	
981	PRE	P	EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC	4.8532	9.500	12.5	
982	PRE	P	EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC	2.7416	5.400	7.1	
983	PRE	P	EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC	1.7615	2.800	3.6	
984	PRE	P	PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC	3.3844	9.300	12.2	
985	PRE	P	PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC	1.9339	4.800	6.7	
986	PRE	P	PROSTATIC O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC	1.2079	2.400	3.4	
987	PRE	P	NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC	3.2123	8.000	10.5	
988	PRE	P	NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC	1.7533	4.600	6.1	
989	PRE	P	NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC	1.0425	2.200	3.0	
998		**	PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS	
999		**	UNGROUPABLE			
							
**MS-DRGs 998 and 999 contain cases that could not be assigned to valid DRGs.	

Final Exhibit #2	
Hospital Base Rates and Cost to Charge Ratio's (CCR)	
Effective for In-Patient Hospital Discharges Occurring on and after 1/1/2016	
Provider Number	Name	 Proposed Hospital Base Rates for 2016 	Total CCR	
60001	NORTH COLORADO MEDICAL CENTER	 $                  6,543.77 	0.226	
60003	LONGMONT UNITED HOSPITAL	 $                  6,060.47 	0.295	
60004	PLATTE VALLEY MEDICAL CENTER	 $                  6,186.24 	0.311	
60006	MONTROSE MEMORIAL HOSPITAL	 $                  5,982.17 	0.368	
60008	SAN LUIS VALLEY HEALTH	 $                  6,073.47 	0.387	
60009	LUTHERAN MEDICAL CENTER	 $                  6,165.94 	0.211	
60010	POUDRE VALLEY HOSPITAL	 $                  6,224.63 	0.335	
60011	DENVER HEALTH MEDICAL CENTER	 $                  7,911.62 	0.268	
60012	CENTURA HEALTH-ST MARY CORWIN MEDICAL CENTER	 $                  6,444.17 	0.234	
60013	MERCY REGIONAL MEDICAL CENTER	 $                  7,723.01 	0.32	
60014	PRESBYTERIAN ST LUKES MEDICAL CENTER	 $                  6,725.35 	0.17	
60015	CENTURA HEALTH-ST ANTHONY HOSPITAL	 $                  6,076.02 	0.186	
60016	CENTURA HEALTH-ST THOMAS MORE HOSPITAL	 $                  6,755.72 	0.38	
60020	PARKVIEW MEDICAL CENTER INC	 $                  6,039.42 	0.167	
60022	UNIVERSITY COLO HEALTH MEMORIAL HOSPITAL CENTRAL	 $                  6,007.56 	0.27	
60023	ST MARYS HOSPITAL AND MEDICAL CENTER	 $                  6,727.38 	0.276	
60024	UNIVERSITY OF COLORADO HOSPITAL ANSCHUTZ INPATIENT	 $                  7,869.15 	0.176	
60027	BOULDER COMMUNITY FOOTHILLS HOSPITAL	 $                  5,935.79 	0.223	
60028	SAINT JOSEPH HOSPITAL	 $                  6,677.61 	0.183	
60030	MCKEE MEDICAL CENTER	 $                  6,078.12 	0.315	
60031	CENTURA HEALTH-PENROSE ST FRANCIS HEALTH SERVICES	 $                  5,966.12 	0.213	
60032	ROSE MEDICAL CENTER	 $                  6,464.53 	0.154	
60034	SWEDISH MEDICAL CENTER	 $                  6,201.30 	0.139	
60036	ARKANSAS VALLEY REGIONAL MEDICAL CENTER	 $                  6,031.60 	0.427	
60043	KEEFE MEMORIAL HOSPITAL	 $                15,522.81 	0.394	
60044	COLORADO PLAINS MEDICAL CENTER	 $                  6,368.64 	0.254	
60049	YAMPA VALLEY MEDICAL CENTER	 $                  9,328.63 	0.524	
60054	COMMUNITY HOSPITAL	 $                  5,784.70 	0.388	
60064	CENTURA HEALTH-PORTER ADVENTIST HOSPITAL	 $                  5,935.20 	0.186	
60065	NORTH SUBURBAN MEDICAL CENTER	 $                  6,263.67 	0.141	
60071	DELTA COUNTY MEMORIAL HOSPITAL	 $                  5,955.18 	0.416	
60075	VALLEY VIEW HOSPITAL ASSOCIATION	 $                  7,982.84 	0.438	
60076	STERLING REGIONAL MEDCENTER	 $                  7,573.46 	0.44	
60096	VAIL VALLEY MEDICAL CENTER	 $                11,688.98 	0.485	
60100	MEDICAL CENTER OF AURORA, THE	 $                  6,094.59 	0.157	
60103	CENTURA HEALTH-AVISTA ADVENTIST HOSPITAL	 $                  6,300.17 	0.247	
60104	ST ANTHONY NORTH HEALTH CAMPUS	 $                  6,813.91 	0.227	
60107	NATIONAL JEWISH HEALTH	 $                  6,252.96 	0.226	
60112	SKY RIDGE MEDICAL CENTER	 $                  5,921.22 	0.133	
60113	CENTURA HEALTH-LITTLETON ADVENTIST HOSPITAL	 $                  5,925.03 	0.161	
60114	PARKER ADVENTIST HOSPITAL	 $                  5,979.42 	0.181	
60116	GOOD SAMARITAN MEDICAL CENTER	 $                  5,900.88 	0.196	
60117	ANIMAS SURGICAL HOSPITAL, LLC	 $                  5,762.75 	0.37	
60118	ST ANTHONY SUMMIT MEDICAL CENTER	 $                  6,011.99 	0.295	
60119	MEDICAL CENTER OF THE ROCKIES	 $                  5,924.72 	0.282	
60124	ORTHOCOLORADO HOSPITAL AT ST ANTHONY MED CAMPUS	 $                  5,881.94 	0.171	
60125	CASTLE ROCK ADVENTIST HOSPITAL	 $                  5,924.62 	0.276	
69999	Any other hospital 	 $                  5,924.62 	0.276	

Final Exhibit #3 	
Effective for Dates of Service on and After 1/1/2016	
Critical Access Hospitals	
Hospital Name	Location in Colorado 	
Aspen Valley Hospital	Aspen	
Colorado Canyons Hospital and Medical Center	Fruita	
East Morgan County Hospital	Brush	
Estes Park Medical Center	Estes Park	
Grand River Hospital District	Rifle	
Gunnison Valley Hospital	Gunnison	
Haxton Hospital District	Haxtun	
Heart of the Rockies Regional Medical Center	Salida	
Kit Carson County Memoral Hospital	Burlington	
Lincoln Community Hospital	Hugo	
Melissa Memorial Hospital	Holyoke	
Middle Park Medical Center	Kremmling/Granby	
Mt San Rafael Hospital	Trinidad	
Pagosa Springs Medical Center	Pagosa Springs	
Pikes Peak Regional Hospital	Woodland Park	
Pioneers Medical Center 	Meeker	
Prowers Medical Center	Lamar	
Rangeley District Hospital	Rangely	
Rio Grande Hospital	Del Norte	
San Luis Valley Hospital	La Jara	
Sedgwick County Health Center	Julesburg	
Southeast Colorado Hospital District	Springfield	
Southwest Memorial Hospital	Cortez	
Spanish Peaks Regional Health District	Walsenburg	
St Vincent General Hospital District	Leadville	
The Memorial Hospital at Craig	Craig	
Weisbrod Memorial County Hospital 	Eads	
Wray Community District Hospital	Wray 	
Yuma District Hospital 	Yuma	

Final Exhibit #4	
Effective for Dates of Service on and After 1/1/2016	
APC	APC Title	 Column #3 - Outpatient Emergency Room Department Facililty Payment Rate minus Devices * 250% 	 Column #4      Outpatient Hospital Facility Payment Rate minus Devices * 170% 	 Column #5 Outpatient Ambulatory Surgery Center (ASC) -  Payment Rate in Column #4*85% 	
4	Level I Needle Biopsy/ Aspiration Except Bone Marrow	 $                       1,216.03 	 $                 826.90 	 $            702.87 	
5	Level II Needle Biopsy/Aspiration Except Bone Marrow	 $                       2,569.48 	 $             1,747.24 	 $         1,485.15 	
6	Level I Incision & Drainage	 $                           402.83 	 $                 273.92 	 $            232.83 	
7	Level II Incision & Drainage	 $                       2,142.83 	 $             1,457.12 	 $         1,238.55 	
8	Level III Incision and Drainage	 $                       4,067.75 	 $             2,766.07 	 $         2,351.16 	
12	Level I Debridement & Destruction	 $                           246.18 	 $                 167.40 	 $            142.29 	
15	Level II Debridement & Destruction	 $                           365.33 	 $                 248.42 	 $            211.16 	
16	Level III Debridement & Destruction	 $                           707.65 	 $                 481.20 	 $            409.02 	
17	Level IV Debridement & Destruction	 $                       3,209.98 	 $             2,182.78 	 $         1,855.36 	
19	Level I Excision/ Biopsy	 $                           946.03 	 $                 643.30 	 $            546.81 	
20	Level II Excision/ Biopsy	 $                       2,056.75 	 $             1,398.59 	 $         1,188.80 	
21	Level III Excision/ Biopsy	 $                       3,341.45 	 $             2,272.19 	 $         1,931.36 	
22	Level IV Excision/ Biopsy	 $                       4,530.23 	 $             3,080.55 	 $         2,618.47 	
28	Level I Breast and Skin Surgery	 $                       5,397.43 	 $             3,670.25 	 $         3,119.71 	
29	Level II Breast and Skin Surgery	 $                       7,372.25 	 $             5,013.13 	 $         4,261.16 	
30	Level III Breast and Skin Surgery	 $                       9,800.25 	 $             6,664.17 	 $         5,664.54 	
31	Level I Health and Behavior Services	 $                             65.05 	 $                   44.23 	 $               37.60 	
39	Level III Neurostimulator & Related Procedures	 $                       6,286.48 	 $             4,274.80 	 $         3,633.58 	
41	Level I Arthroscopy	 $                       5,363.33 	 $             3,647.06 	 $         3,100.00 	
42	Level II Arthroscopy	 $                       9,265.80 	 $             6,300.74 	 $         5,355.63 	
45	Bone/Joint Manipulation Under Anesthesia	 $                       2,870.08 	 $             1,951.65 	 $         1,658.90 	
47	Arthroplasty 	 $                       6,350.95 	 $             4,318.65 	 $         3,670.85 	
49	Level I Musculoskeletal Procedures Except Hand and Foot	 $                       4,118.85 	 $             2,800.82 	 $         2,380.70 	
50	Level II Musculoskeletal Procedures Except Hand and Foot	 $                       5,864.55 	 $             3,987.89 	 $         3,389.71 	
51	Level III Musculoskeletal Procedures Except Hand and Foot	 $                       7,505.30 	 $             5,103.60 	 $         4,338.06 	
52	Level IV Musculoskeletal Procedures Except Hand and Foot	 $                     12,340.50 	 $             8,391.54 	 $         7,132.81 	
53	Level I Hand Musculoskeletal Procedures	 $                       3,061.30 	 $             2,081.68 	 $         1,769.43 	
54	Level II Hand Musculoskeletal Procedures	 $                       5,223.60 	 $             3,552.05 	 $         3,019.24 	
55	Level I Foot Musculoskeletal Procedures	 $                       4,195.78 	 $             2,853.13 	 $         2,425.16 	
56	Level II Foot Musculoskeletal Procedures	 $                       7,997.05 	 $             5,437.99 	 $         4,622.29 	
57	Bunion Procedures	 $                       5,606.53 	 $             3,812.44 	 $         3,240.57 	
58	Level II Strapping and Cast Application	 $                           558.18 	 $                 379.56 	 $            322.63 	
59	Level I Strapping and Cast Application	 $                           319.60 	 $                 217.33 	 $            184.73 	
60	Manipulation Therapy	 $                             49.58 	 $                   33.71 	 $               28.65 	
61	Level II Neurostimulator & Related Procedures	 $                       5,851.45 	 $             3,978.99 	 $         3,382.14 	
62	Level I Treatment Fracture/Dislocation	 $                       4,745.08 	 $             3,226.65 	 $         2,742.65 	
63	Level II Treatment Fracture/Dislocation	 $                       7,700.98 	 $             5,236.66 	 $         4,451.16 	
64	Level III Treatment Fracture/Dislocation	 $                       7,910.05 	 $             5,378.83 	 $         4,572.01 	
66	Level V Radiation Therapy	 $                       4,758.05 	 $             3,235.47 	 $         2,750.15 	
67	Single Session Cranial Stereotactic Radiosurgery	 $                     24,418.18 	 $           16,604.36 	 $       14,113.71 	
69	Thoracoscopy	 $                       7,627.03 	 $             5,186.38 	 $         4,408.42 	
70	Thoracentesis/Lavage Procedures	 $                       1,176.03 	 $                 799.70 	 $            679.75 	
71	Level I Endoscopy Upper Airway	 $                           376.55 	 $                 256.05 	 $            217.64 	
72	Level II Endoscopy Upper Airway	 $                           961.95 	 $                 654.13 	 $            556.01 	
73	Level III Endoscopy Upper Airway	 $                       3,076.78 	 $             2,092.21 	 $         1,778.38 	
74	Level IV Endoscopy Upper Airway	 $                       4,889.95 	 $             3,325.17 	 $         2,826.39 	
75	Level V Endoscopy Upper Airway	 $                       7,081.95 	 $             4,815.73 	 $         4,093.37 	
76	Level I Endoscopy Lower Airway	 $                       2,632.53 	 $             1,790.12 	 $         1,521.60 	
77	Pulmonary Treatment	 $                           411.20 	 $                 279.62 	 $            237.68 	
79	Ventilation Initiation and Management	 $                           933.15 	 $                 634.54 	 $            539.36 	
80	Diagnostic Cardiac Catheterization	 $                       5,664.73 	 $             3,852.01 	 $         3,274.21 	
83	Level I Endovascular Procedures	 $                       8,640.40 	 $             5,875.47 	 $         4,994.15 	
84	Level I Electrophysiologic Procedures	 $                       2,170.28 	 $             1,475.79 	 $         1,254.42 	
85	Level II Electrophysiologic Procedures	 $                       7,856.55 	 $             5,342.45 	 $         4,541.08 	
86	Level III Electrophysiologic Procedures	 $                     22,297.38 	 $           15,162.22 	 $       12,887.89 	
88	Thrombectomy	 $                       7,383.03 	 $             5,020.46 	 $         4,267.39 	
89	Level III Pacemaker and Similar Procedures	 $                       7,775.13 	 $             5,287.09 	 $         4,494.03 	
90	Level II Pacemaker and Similar Procedures	 $                       5,831.90 	 $             3,965.69 	 $         3,370.84 	
93	Vascular Reconstruction/Fistula Repair 	 $                       4,697.83 	 $             3,194.52 	 $         2,715.34 	
94	Resuscitation and Cardioversion	 $                       1,175.30 	 $                 799.20 	 $            679.32 	
95	Cardiac Rehabilitation	 $                           258.25 	 $                 175.61 	 $            149.27 	
96	Level II Noninvasive Physiologic Studies	 $                           824.10 	 $                 560.39 	 $            476.33 	
97	Level I Noninvasive Physiologic Studies	 $                           281.70 	 $                 191.56 	 $            162.83 	
99	Electrocardiograms/Cardiography	 $                           195.98 	 $                 133.26 	 $            113.27 	
100	Cardiac Stress Tests	 $                           595.05 	 $                 404.63 	 $            343.94 	
103	Miscellaneous Vascular Procedures	 $                       3,762.83 	 $             2,558.72 	 $         2,174.91 	
105	Level I Pacemaker & Similar Procedures	 $                       4,291.93 	 $             2,918.51 	 $         2,480.73 	
107	Level I ICD and Similar Procedures	 $                     12,409.35 	 $             8,438.36 	 $         7,172.61 	
108	Level II ICD and Similar Procedures	 $                     15,686.58 	 $           10,666.87 	 $         9,066.84 	
110	Transfusion	 $                           743.03 	 $                 505.26 	 $            429.47 	
111	Blood Product Exchange	 $                       2,637.98 	 $             1,793.82 	 $         1,524.75 	
112	Apheresis and Stem Cell Procedures	 $                       7,113.08 	 $             4,836.89 	 $         4,111.36 	
113	Excision Lymphatic System	 $                       5,837.80 	 $             3,969.70 	 $         3,374.25 	
114	Thyroid/Lymphadenectomy Procedures	 $                     10,532.25 	 $             7,161.93 	 $         6,087.64 	
121	Level I Tube or Catheter Changes or Repositioning	 $                       1,108.38 	 $                 753.70 	 $            640.65 	
126	Level I Urinary and Anal Procedures	 $                           282.58 	 $                 192.15 	 $            163.33 	
129	Level I Closed Treatment Fracture	 $                           422.35 	 $                 287.20 	 $            244.12 	
130	Level I Laparoscopy	 $                       7,164.45 	 $             4,871.83 	 $         4,141.06 	
131	Level II Laparoscopy	 $                       9,088.50 	 $             6,180.18 	 $         5,253.15 	
132	Level III Laparoscopy	 $                     11,144.55 	 $             7,578.29 	 $         6,441.55 	
138	Level II Closed Treatment Fracture 	 $                           533.73 	 $                 362.93 	 $            308.49 	
139	Level III Closed Treatment Fracture 	 $                       1,741.58 	 $             1,184.27 	 $         1,006.63 	
141	Level I Upper GI Procedures	 $                       1,858.23 	 $             1,263.59 	 $         1,074.05 	
142	Level I Small Intestine Endoscopy	 $                       2,089.10 	 $             1,420.59 	 $         1,207.50 	
143	Lower GI Endoscopy	 $                       1,971.50 	 $             1,340.62 	 $         1,139.53 	
146	Level I Sigmoidoscopy and Anoscopy	 $                       1,232.25 	 $                 837.93 	 $            712.24 	
147	Level II Sigmoidoscopy and Anoscopy	 $                       1,998.23 	 $             1,358.79 	 $         1,154.97 	
148	Level I Anal/Rectal Procedures	 $                       1,102.95 	 $                 750.01 	 $            637.51 	
149	Level III Anal/Rectal Procedures	 $                       4,839.50 	 $             3,290.86 	 $         2,797.23 	
150	Level IV Anal/Rectal Procedures	 $                       6,314.08 	 $             4,293.57 	 $         3,649.53 	
151	Endoscopic Retrograde Cholangio-Pancreatography (ERCP)	 $                       4,355.33 	 $             2,961.62 	 $         2,517.38 	
152	Level I Percutaneous Abdominal and Biliary Procedures	 $                       3,777.00 	 $             2,568.36 	 $         2,183.11 	
153	Peritoneal and Abdominal Procedures	 $                       5,611.90 	 $             3,816.09 	 $         3,243.68 	
154	Hernia/Hydrocele Procedures	 $                       5,851.18 	 $             3,978.80 	 $         3,381.98 	
155	Level II Anal/Rectal Procedures	 $                       3,628.80 	 $             2,467.58 	 $         2,097.44 	
156	Level III Urinary and Anal Procedures	 $                           925.65 	 $                 629.44 	 $            535.02 	
157	Colorectal Cancer Screening: Barium Enema	 $                           858.83 	 $                 584.00 	 $            496.40 	
158	Colorectal Cancer Screening: Colonoscopy	 $                       1,637.28 	 $             1,113.35 	 $            946.35 	
159	Colorectal Cancer Screening: Flexible Sigmoidoscopy	 $                       1,169.70 	 $                 795.40 	 $            676.09 	
160	Level I Cystourethroscopy and other Genitourinary Procedures	 $                       1,367.93 	 $                 930.19 	 $            790.66 	
161	Level II Cystourethroscopy and other Genitourinary Procedures	 $                       2,981.18 	 $             2,027.20 	 $         1,723.12 	
162	Level III Cystourethroscopy and other Genitourinary Procedures	 $                       4,965.08 	 $             3,376.25 	 $         2,869.81 	
163	Level IV Cystourethroscopy and other Genitourinary Procedures	 $                       7,724.45 	 $             5,252.63 	 $         4,464.74 	
164	Level II Urinary and Anal Procedures	 $                           527.55 	 $                 358.73 	 $            304.92 	
165	Level IV Urinary and Anal Procedures	 $                       3,178.70 	 $             2,161.52 	 $         1,837.29 	
166	Level I Urethral Procedures	 $                       4,046.65 	 $             2,751.72 	 $         2,338.96 	
168	Level II Urethral Procedures	 $                       4,107.55 	 $             2,793.13 	 $         2,374.16 	
170	Dialysis	 $                       1,529.33 	 $             1,039.94 	 $            883.95 	
174	Level IV Laparoscopy	 $                     16,954.88 	 $           11,529.32 	 $         9,799.92 	
177	Level I Echocardiogram with Contrast	 $                       1,225.95 	 $                 833.65 	 $            708.60 	
178	Level II Echocardiogram with Contrast	 $                       1,721.38 	 $             1,170.54 	 $            994.96 	
181	Level II Male Genital Procedures	 $                       5,552.23 	 $             3,775.51 	 $         3,209.18 	
183	Level I Male Genital Procedures	 $                       4,522.75 	 $             3,075.47 	 $         2,614.15 	
184	Prostate Biopsy	 $                       3,653.20 	 $             2,484.18 	 $         2,111.55 	
188	Level I Gynecologic Procedures	 $                           326.40 	 $                 221.95 	 $            188.66 	
189	Level II Gynecologic Procedures	 $                           565.05 	 $                 384.23 	 $            326.60 	
192	Level III Gynecologic Procedures	 $                       1,216.68 	 $                 827.34 	 $            703.24 	
193	Level IV Gynecologic Procedures	 $                       4,573.95 	 $             3,110.29 	 $         2,643.75 	
202	Level V Gynecologic Procedures	 $                       8,097.63 	 $             5,506.39 	 $         4,680.43 	
203	Level IV Nerve Injections	 $                       3,668.45 	 $             2,494.55 	 $         2,120.37 	
204	Level I Nerve Injections	 $                           527.98 	 $                 359.02 	 $            305.17 	
205	Level III Male Genital Procedures	 $                       7,158.93 	 $             4,868.07 	 $         4,137.86 	
206	Level II Nerve Injections	 $                           931.35 	 $                 633.32 	 $            538.32 	
207	Level III Nerve Injections	 $                       1,678.80 	 $             1,141.58 	 $            970.34 	
208	Laminotomies and Laminectomies	 $                     10,080.35 	 $             6,854.64 	 $         5,826.44 	
209	Level II Extended EEG, Sleep, and Cardiovascular Studies	 $                           577.08 	 $                 392.41 	 $            333.55 	
210	Spinal Fusions	 $                     10,080.35 	 $             6,854.64 	 $         5,826.44 	
213	Level I Extended EEG, Sleep, and Cardiovascular Studies	 $                           441.58 	 $                 300.27 	 $            255.23 	
215	Level I Nerve and Muscle Services	 $                           237.40 	 $                 161.43 	 $            137.22 	
216	Level III Nerve and Muscle Services	 $                           681.63 	 $                 463.51 	 $            393.98 	
218	Level II Nerve and Muscle Services	 $                           397.15 	 $                 270.06 	 $            229.55 	
219	Vascular Ligation 	 $                       4,838.05 	 $             3,289.87 	 $         2,796.39 	
220	Level I Nerve Procedures	 $                       3,450.83 	 $             2,346.56 	 $         1,994.58 	
221	Level II Nerve Procedures	 $                       6,477.23 	 $             4,404.51 	 $         3,743.83 	
224	Implantation of Catheter/Reservoir/Shunt	 $                       6,394.80 	 $             4,348.46 	 $         3,696.19 	
227	Implantation of Drug Infusion Device	 $                       8,782.85 	 $             5,972.34 	 $         5,076.49 	
229	Level II Endovascular Procedures	 $                     14,338.30 	 $             9,750.04 	 $         8,287.53 	
230	Level I Eye Tests & Treatments	 $                           130.15 	 $                   88.50 	 $               75.23 	
231	Level III Eye Tests & Treatments	 $                           786.03 	 $                 534.50 	 $            454.33 	
233	Level II Intraocular Procedures	 $                       3,752.80 	 $             2,551.90 	 $         2,169.12 	
238	Level I Extraocular, Repair, and Plastic Eye Procedures	 $                           739.03 	 $                 502.54 	 $            427.16 	
239	Level II Extraocular, Repair, and Plastic Eye Procedures	 $                       1,724.50 	 $             1,172.66 	 $            996.76 	
240	Level III Extraocular, Repair, and Plastic Eye Procedures	 $                       3,763.00 	 $             2,558.84 	 $         2,175.01 	
242	Level IV Extraocular, Repair, and Plastic Eye Procedures	 $                       5,979.00 	 $             4,065.72 	 $         3,455.86 	
247	Laser Eye Procedures	 $                       1,108.63 	 $                 753.87 	 $            640.79 	
250	Level I ENT Procedures	 $                           323.75 	 $                 220.15 	 $            187.13 	
251	Level II ENT Procedures	 $                           903.68 	 $                 614.50 	 $            522.33 	
252	Level III ENT Procedures	 $                       1,609.85 	 $             1,094.70 	 $            930.50 	
253	Level IV ENT Procedures	 $                       3,114.58 	 $             2,117.91 	 $         1,800.22 	
254	Level V ENT Procedures	 $                       4,814.40 	 $             3,273.79 	 $         2,782.72 	
255	Level I Intraocular Procedures	 $                       1,869.93 	 $             1,271.55 	 $         1,080.82 	
256	Level VI ENT Procedures	 $                       9,054.65 	 $             6,157.16 	 $         5,233.59 	
259	Level VII ENT Procedures	 $                     13,388.18 	 $             9,103.96 	 $         7,738.37 	
260	Level I Plain Film Including Bone Density Measurement	 $                           148.43 	 $                 100.93 	 $               85.79 	
261	Level II Plain Film Including Bone Density Measurement	 $                           237.53 	 $                 161.52 	 $            137.29 	
263	Level I Miscellaneous Radiology Procedures	 $                           819.58 	 $                 557.31 	 $            473.71 	
265	Level I Diagnostic and Screening Ultrasound	 $                           229.23 	 $                 155.87 	 $            132.49 	
266	Level II Diagnostic and Screening Ultrasound	 $                           337.13 	 $                 229.25 	 $            194.86 	
267	Level III Diagnostic and Screening Ultrasound	 $                           474.00 	 $                 322.32 	 $            273.97 	
269	Level I Echocardiogram Without Contrast 	 $                       1,056.88 	 $                 718.68 	 $            610.88 	
270	Level II Echocardiogram Without Contrast 	 $                       1,485.35 	 $             1,010.04 	 $            858.53 	
272	Fluoroscopy and Other Radiology Services	 $                           385.90 	 $                 262.41 	 $            223.05 	
274	Myelography	 $                       1,535.40 	 $             1,044.07 	 $            887.46 	
275	Arthrography	 $                           846.38 	 $                 575.54 	 $            489.21 	
276	Level I Digestive Radiology	 $                           254.23 	 $                 172.87 	 $            146.94 	
277	Level II Digestive Radiology	 $                           377.18 	 $                 256.48 	 $            218.01 	
278	Diagnostic Urography	 $                           655.78 	 $                 445.93 	 $            379.04 	
279	Level II Angiography and Venography	 $                       5,357.05 	 $             3,642.79 	 $         3,096.37 	
280	Level III Angiography and Venography	 $                     11,865.90 	 $             8,068.81 	 $         6,858.49 	
283	Computed Tomography with Contrast	 $                           602.18 	 $                 409.48 	 $            348.06 	
284	Magnetic Resonance Imaging and Magnetic Resonance Angiography with Contrast	 $                       1,067.60 	 $                 725.97 	 $            617.07 	
293	Level IV Intraocular Procedures	 $                       9,472.28 	 $             6,441.15 	 $         5,474.98 	
300	Level I Radiation Therapy	 $                           250.33 	 $                 170.22 	 $            144.69 	
301	Level II Radiation Therapy	 $                           483.10 	 $                 328.51 	 $            279.23 	
303	Treatment Device Construction	 $                           538.98 	 $                 366.50 	 $            311.53 	
304	Level I Therapeutic Radiation Treatment Preparation	 $                           282.93 	 $                 192.39 	 $            163.53 	
305	Level II Therapeutic Radiation Treatment Preparation	 $                           786.38 	 $                 534.74 	 $            454.53 	
308	Positron Emission Tomography (PET) imaging	 $                       3,215.25 	 $             2,186.37 	 $         1,858.41 	
310	Level III Therapeutic Radiation Treatment Preparation	 $                       2,577.90 	 $             1,752.97 	 $         1,490.02 	
312	Radioelement Applications	 $                           989.80 	 $                 673.06 	 $            572.10 	
313	Brachytherapy	 $                       1,823.65 	 $             1,240.08 	 $         1,054.07 	
317	Level II Miscellaneous Radiology Procedures	 $                       1,897.40 	 $             1,290.23 	 $         1,096.70 	
318	Level IV Neurostimulator & Related Procedures	 $                     10,111.78 	 $             6,876.01 	 $         5,844.61 	
319	Level III Endovascular Procedures	 $                     19,296.68 	 $           13,121.74 	 $       11,153.48 	
320	Electroconvulsive Therapy	 $                       1,115.73 	 $                 758.69 	 $                     -   	
322	Brief Individual Psychotherapy	 $                           223.73 	 $                 152.13 	 $                     -   	
323	Extended Individual Psychotherapy	 $                           288.80 	 $                 196.38 	 $                     -   	
324	Family Psychotherapy	 $                           310.00 	 $                 210.80 	 $                     -   	
325	Group Psychotherapy	 $                           165.13 	 $                 112.29 	 $                     -   	
326	Level I Skin Procedures	 $                           549.65 	 $                 373.76 	 $            317.70 	
327	Level II Skin Procedures	 $                       1,074.13 	 $                 730.41 	 $            620.85 	
328	Level III Skin Procedures	 $                       3,512.23 	 $             2,388.31 	 $         2,030.06 	
329	Level IV Skin Procedures	 $                       5,678.48 	 $             3,861.36 	 $         3,282.16 	
330	Dental Procedures	 $                           632.35 	 $                 430.00 	 $            365.50 	
331	Combined Abdomen and Pelvis CT without Contrast 	 $                           592.03 	 $                 402.58 	 $            342.19 	
332	Computed Tomography without Contrast	 $                           300.05 	 $                 204.03 	 $            173.43 	
333	Computed Tomography without Contrast followed by Contrast	 $                           674.20 	 $                 458.46 	 $            389.69 	
334	Combined Abdomen and Pelvis CT with Contrast 	 $                           938.73 	 $                 638.33 	 $            542.58 	
336	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast	 $                           715.95 	 $                 486.85 	 $            413.82 	
337	Magnetic Resonance Imaging and Magnetic Resonance Angiography without Contrast followed by Contrast	 $                       1,206.85 	 $                 820.66 	 $            697.56 	
340	Level II Minor Procedures	 $                           130.93 	 $                   89.03 	 $               75.68 	
342	Level I Pathology	 $                           135.65 	 $                   92.24 	 $               78.40 	
345	Level I Transfusion Laboratory Procedures	 $                           190.00 	 $                 129.20 	 $            109.82 	
346	Level II Transfusion Laboratory Procedures	 $                           312.10 	 $                 212.23 	 $            180.40 	
351	Level V Intraocular Procedures	 $                       5,880.73 	 $             3,998.89 	 $         3,399.06 	
360	Level I Alimentary Tests	 $                           352.75 	 $                 239.87 	 $            203.89 	
361	Level II Alimentary Tests	 $                           816.98 	 $                 555.54 	 $            472.21 	
363	Otorhinolaryngologic and Related Tests	 $                           357.53 	 $                 243.12 	 $            206.65 	
364	Level I Audiometry	 $                           108.30 	 $                   73.64 	 $               62.59 	
365	Level II Audiometry	 $                           294.88 	 $                 200.52 	 $            170.44 	
367	Level I Pulmonary Tests	 $                           403.08 	 $                 274.09 	 $            232.98 	
369	Level II Pulmonary Tests	 $                           591.98 	 $                 402.54 	 $            342.16 	
373	Neuropsychological Testing	 $                           498.33 	 $                 338.86 	 $            288.03 	
375	Ancillary Outpatient Services When Patient Expires	 $                     12,965.65 	 $             8,816.64 	 $         7,494.14 	
377	Level II Cardiac Imaging	 $                       2,851.35 	 $             1,938.92 	 $         1,648.08 	
378	Level II Pulmonary Imaging	 $                       1,100.40 	 $                 748.27 	 $            636.03 	
383	Cardiac Computed Tomographic Imaging	 $                           539.98 	 $                 367.18 	 $            312.10 	
384	GI Procedures with Stents	 $                       6,115.98 	 $             4,158.86 	 $         3,535.03 	
385	Level I Urogenital Procedures	 $                     10,285.30 	 $             6,994.00 	 $         5,944.90 	
386	Level II Urogenital Procedures	 $                     10,682.68 	 $             7,264.22 	 $         6,174.59 	
388	Discography	 $                       8,314.38 	 $             5,653.78 	 $         4,805.71 	
389	Level I Non-imaging Nuclear Medicine	 $                           472.90 	 $                 321.57 	 $            273.33 	
390	Level I Endocrine Imaging	 $                           474.80 	 $                 322.86 	 $            274.43 	
391	Level II Endocrine Imaging	 $                           705.00 	 $                 479.40 	 $            407.49 	
392	Level II Non-imaging Nuclear Medicine	 $                           700.25 	 $                 476.17 	 $            404.74 	
393	Hematologic Processing & Studies	 $                       1,570.33 	 $             1,067.82 	 $            907.65 	
394	Hepatobiliary Imaging	 $                           932.53 	 $                 634.12 	 $            539.00 	
395	GI Tract Imaging	 $                           817.38 	 $                 555.82 	 $            472.45 	
396	Bone Imaging	 $                           830.78 	 $                 564.93 	 $            480.19 	
398	Level I Cardiac Imaging	 $                           933.73 	 $                 634.93 	 $            539.69 	
400	Hematopoietic Imaging	 $                           922.43 	 $                 627.25 	 $            533.16 	
401	Level I Pulmonary Imaging	 $                           789.03 	 $                 536.54 	 $            456.06 	
402	Level II Nervous System Imaging	 $                       1,393.13 	 $                 947.33 	 $            805.23 	
403	Level I Nervous System Imaging	 $                           442.65 	 $                 301.00 	 $            255.85 	
404	Renal and Genitourinary Studies	 $                       1,051.45 	 $                 714.99 	 $            607.74 	
406	Level I Tumor/Infection Imaging	 $                           943.13 	 $                 641.33 	 $            545.13 	
407	Radionuclide Therapy	 $                           691.98 	 $                 470.54 	 $            399.96 	
408	Level III Tumor/Infection Imaging	 $                       2,971.85 	 $             2,020.86 	 $         1,717.73 	
412	Level III Radiation Therapy	 $                       1,269.38 	 $                 863.18 	 $            733.70 	
414	Level II Tumor/Infection Imaging	 $                       1,766.30 	 $             1,201.08 	 $         1,020.92 	
415	Level II Endoscopy Lower Airway	 $                       5,245.48 	 $             3,566.92 	 $         3,031.88 	
419	Level II Upper GI Procedures 	 $                       2,455.03 	 $             1,669.42 	 $         1,419.01 	
420	Level III Minor Procedures	 $                           328.65 	 $                 223.48 	 $            189.96 	
422	Level III Upper GI Procedures	 $                       3,690.50 	 $             2,509.54 	 $         2,133.11 	
423	Level II Percutaneous Abdominal and Biliary Procedures	 $                       7,739.18 	 $             5,262.64 	 $         4,473.24 	
424	Level II Small Intestine Endoscopy 	 $                       3,040.10 	 $             2,067.27 	 $         1,757.18 	
425	Level V Musculoskeletal Procedures Except Hand and Foot	 $                     12,187.00 	 $             8,287.16 	 $         7,044.09 	
427	Level II Tube or Catheter Changes or Repositioning	 $                       2,482.10 	 $             1,687.83 	 $         1,434.66 	
428	Level III Sigmoidoscopy and Anoscopy	 $                       4,135.05 	 $             2,811.83 	 $         2,390.06 	
431	Level IV Closed Treatment Fracture	 $                       3,103.30 	 $             2,110.24 	 $         1,793.70 	
432	Level II Health and Behavior Services	 $                           125.60 	 $                   85.41 	 $               72.60 	
433	Level II Pathology	 $                           457.43 	 $                 311.05 	 $            264.39 	
435	Level III Extended EEG, Sleep, and Cardiovascular Studies	 $                       2,135.73 	 $             1,452.29 	 $         1,234.45 	
436	Level I Drug Administration	 $                             81.45 	 $                   55.39 	 $               47.08 	
437	Level II Drug Administration	 $                           133.85 	 $                   91.02 	 $               77.37 	
438	Level III Drug Administration	 $                           270.50 	 $                 183.94 	 $            156.35 	
439	Level IV Drug Administration	 $                           433.80 	 $                 294.98 	 $            250.73 	
440	Level V Drug Administration	 $                           712.63 	 $                 484.59 	 $            411.90 	
442	Dosimetric Drug Administration	 $                       2,878.98 	 $             1,957.70 	 $         1,664.05 	
446	Level IV Nerve and Muscle Services	 $                       3,252.40 	 $             2,211.63 	 $         1,879.89 	
450	Level I Minor Procedures	 $                             73.03 	 $                   49.66 	 $               42.21 	
609	Level 1 Type A Emergency Visits - only payable when services are conducted in an outpatient hospital ERD	 $                           151.20 	 $                          -   	 $                     -   	
613	Level 2 Type A Emergency Visits - only payable when services are conducted in an outpatient hospital ERD	 $                           281.95 	 $                          -   	 $                     -   	
614	Level 3 Type A Emergency Visits - only payable when services are conducted in an outpatient hospital ERD	 $                           495.88 	 $                          -   	 $                     -   	
615	Level 4 Type A Emergency Visits - only payable when services are conducted in an outpatient hospital ERD	 $                           834.43 	 $                          -   	 $                     -   	
616	Level 5 Type A Emergency Visits - only payable when services are conducted in an outpatient hospital ERD	 $                       1,231.60 	 $                          -   	 $                     -   	
617	Critical Care	 In Rule 18-6 	 In Rule 18-6 	 $                     -   	
618	Trauma Response with Critical Care	 In Rule 18-6 	 In Rule 18-6 	 $                     -   	
621	Level I Vascular Access Procedures	 $                       1,804.88 	 $             1,227.32 	 $         1,043.22 	
622	Level II Vascular Access Procedures	 $                       3,892.80 	 $             2,647.10 	 $         2,250.04 	
624	Phlebotomy and Minor Vascular Access Device Procedures	 $                           196.93 	 $                 133.91 	 $            113.82 	
626	Level 1 Type B Emergency Visits	 $                           156.78 	 	 	
627	Level 2 Type B Emergency Visits	 $                           173.78 	 	 	
628	Level 3 Type B Emergency Visits	 $                           282.43 	 	 	
629	Level 4 Type B Emergency Visits	 $                           497.40 	 	 	
630	Level 5 Type B Emergency Visits	 $                           760.95 	 	 	
631	Level 1 Examinations & Related Services 	 $                                    -   	 $                          -   	 $                     -   	
632	Level 2 Examinations & Related Services 	 $                                    -   	 $                          -   	 $                     -   	
633	Level 3 Examinations & Related Services 	 $                                    -   	 $                          -   	 $                     -   	
634	Hospital Clinic Visits	 $                                    -   	 $                          -   	 $                     -   	
648	Level IV Breast and Skin Surgery	 $                     12,366.50 	 $             8,409.22 	 $         7,147.84 	
651	Complex Interstitial Radiation Source Application	 $                       2,331.68 	 $             1,585.54 	 $         1,347.71 	
652	Insertion of Intraperitoneal and Pleural Catheters	 $                       4,386.55 	 $             2,982.85 	 $         2,535.42 	
655	Level IV Pacemaker and Similar Procedures	 $                     11,985.60 	 $             8,150.21 	 $         6,927.68 	
659	Hyperbaric Oxygen	 $                           273.23 	 $                 185.79 	 $            157.92 	
661	Level III Pathology	 $                           732.40 	 $                 498.03 	 $            423.33 	
662	CT Angiography	 $                           704.65 	 $                 479.16 	 $            407.29 	
667	Level IV Radiation Therapy	 $                       2,680.93 	 $             1,823.03 	 $         1,549.58 	
668	Level I Angiography and Venography	 $                       1,796.55 	 $             1,221.65 	 $         1,038.40 	
673	Level III Intraocular Procedures	 $                       7,370.80 	 $             5,012.14 	 $         4,260.32 	
676	Thrombolysis and Other Device Revisions 	 $                           479.40 	 $                 325.99 	 $            277.09 	
688	Level I Neurostimulator & Related Procedures	 $                       5,195.90 	 $             3,533.21 	 $         3,003.23 	
690	Level I Electronic Analysis of Devices	 $                             87.88 	 $                   59.76 	 $               50.80 	
691	Level III Electronic Analysis of Devices	 $                           618.68 	 $                 420.70 	 $            357.60 	
692	Level II Electronic Analysis of Devices	 $                           320.38 	 $                 217.86 	 $            185.18 	
698	Level II Eye Tests & Treatments	 $                           252.13 	 $                 171.45 	 $            145.73 	
8001	LDR Prostate Brachytherapy Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	
8004	Ultrasound Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	
8005	CT and CTA without Contrast Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	
8006	CT and CTA with Contrast Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	
8007	MRI and MRA without Contrast Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	
8008	MRI and MRA with Contrast Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	
8009	Extended Assessment & Management Composite	 Agreement with Payer is Required  	 Agreement with Payer is Required  	 Agreement with Payer is Required  	

Final - Exhibit #5	
Effective for Dates of Service on and After 1/1/2016	
Rural Health Facilities 	
AKRON CLINIC	
82 MAIN	
AKRON, CO 80720 - WASHINGTON COUNTY	
Telephone: (970)345-6336, Fax: (970)345-6576	
	
ARKANSAS VALLEY FAMILY PRACTICE, LLC	
2317 SAN JUAN AVE	
LA JUNTA, CO 81050 - OTERO COUNTY	
Telephone: (719)383-2325, Fax: (719)383-2327	
	
BASIN CLINIC	
421 WEST ADAMS ROAD	
NATURITA, CO 81422 - MONTROSE COUNTY	
Telephone: (970)865-2665, Fax: (970)825-2674	
	
BRUSH FAMILY CLINIC	
2400 W EDISON	
BRUSH, CO 80723 - MORGAN COUNTY	
Telephone: (970)842-6740, Fax: (970)842-6241	
Administrator/Contact: LARRA ATWATER	
	
BUENA VISTA HEALTH CENTER	
28374 COUNTY ROAD 317	
BUENA VISTA, CO 81211 - CHAFFEE COUNTY	
Telephone: (719)395-9048, Fax: (719)395-9064	
	
BUTTON FAMILY PRACTICE	
715 SOUTH 9TH STREET	
CANON CITY, CO 81212 - FREMONT COUNTY	
Telephone: (719)269-8820, Fax: (719)204-0230	
	
CENTENNIAL FAMILY HEALTH CENTER	
319 MAIN STREET	
ORDWAY, CO 81063 - CROWLEY COUNTY	
Telephone: (719)267-3503, Fax: (719)267-4153	
	
CORTEZ PRIMARY CARE CLINIC	
118 NORTH CHESTNUT	
CORTEZ, CO 81321 - MONTEZUMA COUNTY	
Telephone: (970)564-9777, Fax: (970)564-8833	
	
CREEDE FAMILY PRACTICE OF RIO GRANDE HOSPITAL	
802 RIO GRANDE AVENUE	
CREEDE, CO 81130 - MINERAL COUNTY	
Telephone: (719)658-0929, Fax: (719)657-2851	
	
CUSTER COUNTY MEDICAL CENTER	
704 EDWARDS	
WESTCLIFFE, CO 81252 - CUSTER COUNTY	
Telephone: (719)783-2380, Fax: (719)783-2377	
Administrator/Contact: Mr DELWIN LESTER	
	
DOLORES MEDICAL CENTER	
507 CENTRAL AVENUE	
DOLORES, CO 81323 - MONTEZUMA COUNTY	
Telephone: (970)882-7221, Fax: (970)882-4243	
	
EADS MEDICAL CLINIC	
1211 LUTHER STREET	
EADS, CO 81036 - KIOWA COUNTY	
Telephone: (719)438-2251, Fax: (719)438-2254	
	
EASTERN PLAINS MEDICAL CLINIC OF CALHAN	
560 CRYSTOLA STREET	
CALHAN, CO 80808 - EL PASO COUNTY	
Telephone: (719)347-0100, Fax: (719)347-0551	
	
FAMILY CARE CLINIC	
615 FAIRHURST	
STERLING, CO 80751 - LOGAN COUNTY	
Telephone: (970)521-3223, Fax: (970)521-3266	
	
FAMILY PRACTICE OF HOLYOKE	
1001 EAST JOHNSON STREET	
HOLYOKE, CO 80734 - PHILLIPS COUNTY	
Telephone: (970)854-2500, Fax: (970)854-3440	
	
FLORENCE MEDICAL CENTER	
501 W 5TH ST	
FLORENCE, CO 81226 - FREMONT COUNTY	
Telephone: (719)784-4816, Fax: (719)784-6014	
Administrator/Contact: DR JOSEPH MCGARRY	
	
FORT MORGAN PEDIATRIC CLINIC, PC	
1000 LINCOLN STREET, STE 202	
FORT MORGAN, CO 80701 - MORGAN COUNTY	
Telephone: (970)542-9187, Fax: (970)867-9187	
	
GRAND RIVER HEALTH CLINIC WEST	
201 SIPPERELLE DRIVE	
PARACHUTE, CO 81635 - GARFIELD COUNTY	
Telephone: (970)285-7046, Fax: (970)285-6064	
	
GRAND RIVER PRIMARY CARE	
501 AIRPORT ROAD	
RIFLE, CO 81650 - GARFIELD COUNTY	
Telephone: (970)625-1100, Fax: (970)625-0725	
	
KIT CARSON CLINIC	
102 EAST 2ND AVENUE	
KIT CARSON, CO 80825 - CHEYENNE COUNTY	
Telephone: (719)962-3501, Fax: (719)962-3403	
	
LAKE CITY AREA MEDICAL CENTER	
700 N HENSON STREET	
LAKE CITY, CO 81235 - HINSDALE COUNTY	
Telephone: (970)944-2331, Fax: (970)944-2320	
	
LAMAR MEDICAL CLINIC	
403 KENDALL DRIVE	
LAMAR, CO 81052 - PROWERS COUNTY	
Telephone: (719)336-6767, Fax: (719)336-7217	
	
LAS ANIMAS FAMILY PRACTICE	
304 CARSON AVENUE	
LAS ANIMAS, CO 81054 - BENT COUNTY	
Telephone: (719)456-6000, Fax: (719)456-9701	
	
MANCOS VALLEY HEALTH CENTER	
111 RAILROAD AVE	
MANCOS, CO 81328 - MONTEZUMA COUNTY	
Telephone: (970)564-2104, Fax: (970)564-2134	
	
MEEKER FAMILY HEALTH CENTER	
345 CLEVELAND STREET	
MEEKER, CO 81641 - RIO BLANCO COUNTY	
Telephone: (970)878-4014, Fax: (970)878-3285	
	
MT SAN RAFAEL HOSPITAL HEALTH CLINIC	
400 BENEDICTA STE A	
TRINIDAD, CO 81082 - LAS ANIMAS COUNTY	
	
NORTH PARK MEDICAL CENTER - WALDEN	
350 MCKINLEY STREET	
WALDEN, CO 80480 - JACKSON COUNTY	
Telephone: (970)723-4255, Fax: (970)723-4268	
	
PAGOSA MOUNTAIN CLINIC	
95 SOUTH PAGOSA BLVD	
PAGOSA SPRINGS, CO 81147 - ARCHULETA COUNTY	
Telephone: (970)731-3700, Fax: (970)731-3707	
	
PARKE HEALTH CLINIC	
182 16TH ST	
BURLINGTON, CO 80807 - KIT CARSON COUNTY	
Telephone: (719)346-9481, Fax: (719)346-9485	
	
PEDIATRIC ASSOCIATION OF CANON CITY	
1335 PHAY AVENUE, SUITE A	
CANON CITY, CO 81212 - FREMONT COUNTY	
Telephone: (719)269-1727, Fax: (719)269-1730	
	
PRAIRIE VIEW RURAL HEALTH CLINIC	
615 WEST 5TH NORTH	
CHEYENNE WELLS, CO 80810 - CHEYENNE COUNTY	
Telephone: (719)767-5669, Fax: (719)767-8042	
	
R AND D MEDICAL MANAGEMENT CORP	
109 LATIGO LANE, STE C	
CANON CITY, CO 81212 - FREMONT COUNTY	
Telephone: (719)276-3211, Fax: (719)276-3011	
	
RIO GRANDE HOSPITAL CLINIC	
0310C COUNTY RD 14	
DEL NORTE, CO 81132 - RIO GRANDE COUNTY	
Telephone: (719)657-2418, Fax: (719)658-3001	
	
ROCKY FORD FAMILY HEALTH CENTER	
1014 ELM AVENUE	
ROCKY FORD, CO 81067 - OTERO COUNTY	
Telephone: (719)254-7421, Fax: (719)254-6966	
	
SABATINI PEDIATRICS PC	
612 YALE PLACE	
CANON CITY, CO 81212 - FREMONT COUNTY	
Telephone: (719)275-3442, Fax: (719)275-2306	
	
SAN LUIS VALLEY HEALTH ANTONITO CLINIC	
115 MAIN STREET	
ANTONITO, CO 81120 - CONEJOS COUNTY	
Telephone: (719)376-2308, Fax: (719)376-2395	
	
SAN LUIS VALLEY LA JARA MEDICAL CLINIC	
509 MAIN STREET	
LA JARA, CO 81140 - CONEJOS COUNTY	
Telephone: (719)274-5000, Fax: (719)274-4111	
	
SOUTHEAST COLORADO PHYSICIANS CLINIC	
900 CHURCH STREET	
SPRINGFIELD, CO 81073 - BACA COUNTY	
Telephone: (719)523-6628, Fax: (719)523-4513	
	
SOUTHWEST MEMORIAL PRIMARY CARE	
33 NORTH ELM STREET	
CORTEZ, CO 81321 - MONTEZUMA COUNTY	
Telephone: (970)565-8556, Fax: (970)564-1134	
	
SOUTHWEST WALK-IN CARE	
2095 NORTH DOLORES ROAD, STE C	
CORTEZ, CO 81321 - MONTEZUMA COUNTY	
Telephone: (970)564-1037, Fax: (970)564-1041	
	
SPANISH PEAKS FAMILY CLINIC	
23400 US HIGHWAY 160	
WALSENBURG, CO 81089 - HUERFANO COUNTY	
Telephone: (719)738-4591, Fax: (719)738-4553	
	
STRATTON MEDICAL CLINIC	
500 NEBRASKA AVENUE	
STRATTON, CO 80836 - KIT CARSON COUNTY	
Telephone: (719)348-4650, Fax: (719)348-4653	
	
SURFACE CREEK FAMILY PRACTICE	
255 SW 8TH AVE	
CEDAREDGE, CO 81413 - DELTA COUNTY	
Telephone: (970)856-3146, Fax: (970)856-4385	
	
TRINIDAD FAMILY MEDICAL CENTER	
1502 E MAIN ST	
TRINIDAD, CO 81082 - LAS ANIMAS COUNTY	
Telephone: (719)846-3305, Fax: (719)846-4922	
	
VALLEY MEDICAL CLINIC	
116 E NINTH STREET	
JULESBURG, CO 80737 - SEDGWICK COUNTY	
Telephone: (970)474-3376, Fax: (970)474-2461	
Administrator/Contact: Mr DAVID GARNAS	
	
WALSH MEDICAL CLINIC	
137 KANSAS STREET	
WALSH, CO 81090 - BACA COUNTY	
Telephone: (719)324-5253, Fax: (719)324-5621	
	
WASHINGTON COUNTY CLINIC	
482 ADAMS AVENUE	
AKRON, CO 80720 - WASHINGTON COUNTY	
Telephone: (970)345-2262, Fax: (970)345-2265	
	
YUMA CLINIC	
1000 W 8TH AVENUE	
YUMA, CO 80759 - YUMA COUNTY	
Telephone: (970)848-4792, Fax: (970)848-5405	
Administrator/Contact: Mr JOHN GARDNER	
Rural Health Clinics 	
Ownership type: NON PROFIT-CORPORATION	

Exhibit 7
(Effective January 1, 2016)
Evaluation and Management (E&M) Guidelines for Colorado
Workers’ Compensation Claims
This E&M Guidelines for Colorado Workers’ Compensation Claims is intended for the physicians who manage injured workers’ medical and non-medical care.  Providers may use, instead of Exhibit #7 the “1997 Documentation Guidelines for Evaluation and Management Services” as developed by Medicare and available on Medicare’s web siteHistory (Hx),  2.  Examination (Exam), and 3.  Medical Decision Making (MDM) Determines the Level of Service:
New Patient/Office Consultations (CPT consultation criteria must be met before a consultation can be billed for any level of service.)

Level of Service (Requires all three key components at the same level or higher)	1. Hx	2. Exam	3. MDM	Avg. time (minutes) as listed for the specific  CPT©  code	
99201/99241	Problem Focused (PF)	PF	Straight Forward (SF)	10	
99202/99242	Extended Problem Focused (EPF)	EPF	SF	20	
99203/99243	Detailed (D)	D	Low	30	
99204/99244	Comprehensive(C)	C	Moderate	45	
99205/99245	C	C	High	60	
Established Patient Office Visit

Level of Service (Requires at least two of the three key components at the same level or higher)	1. Hx	2. Exam	3. MDM	Avg. time (minutes) as listed for the specific  CPT code	
99211	N/A	N/A	N/A	5	
99212	PF	PF	SF	10	
99213	EPF	EPF	Low	15	
99214	D	D	Moderate	25	
99215	C	C	High	40	
NOTES:  Documentation of a chief complaint and medical necessity is required for any billed office visit.
CPT© criteria for a consultation is still required to bill a consultation code.
1.  History Component – To qualify for a given level of history all three elements in the table below must be met and documented in the record.  Documentation must be patient specific and pertain directly to the current visit.  Information copied directly from prior records without change is not considered current nor counted.

History Elements	Requirements for a Problem Focused (PF) History Level	Requirements for an Expanded Problem Focused  (EPF) History Level	Requirements for a Detailed (D) History Level	Requirements for a Comprehensive (C) History Level	
History of Present Illness/Injury (HPI)	Brief 1-3 elements	Brief 1-3 elements	Extended 4+ elements (required a detailed patient specific description of the patient’s progress with the current TX plan, which should include objective functional gains/losses, ADLs)	Extended 4+ elements (requires a detailed patient specific description of the patient’s progress with the current TX plan, which should include objective functional gains/losses, ADLs)	
Review of Systems (ROS) is not required for established patient visits.	None	Problem pertinent – limited to injured body part	2 to 9 body parts or body systems	Complete 10+	
Past Medical, Family and Social/Work History (PMFSH)	None	None	Pertinent 1 of 4 types of histories	2 or more of the 4 types of histories	
A.	HPI Elements represents the injured worker relaying their condition to the physician and should include the following:
1.	Location (where?)
2.	Quality (sharp, dull)
3.	Severity (pain level 1-10 or pain diagram)
4.	Duration (how long?)
5.	Timing (how often?)
6.	Context (what ADLs or functions aggravates/relieves?)**
7.	Modifying factors (doing what?)
8.	Associated signs (nausea, when?)
For the provider to achieve an “extended” HPI in an established patient/injured worker visit it is necessary to document a detailed description of the patient’s progress since the last visit with current treatment plan that includes patient pertinent objective functional gains, such as ADLs, physical therapy goals and return to work. 
For the provider to achieve an “extended” HPI in an initial patient/injured workersvisit it is necessary for the provider to discuss the causality of the patient/injured worker’s work related injury(s) to the patient/injured worker’s job duties.
B.	Review of Systems (ROS) each system/body part is counted once whether positive or negative:
1.	Constitutional symptoms (e.g., fever, weight loss)
2.	Eyes
3.	Ears, Nose, Mouth, Throat
4.	Cardiovascular
5.	Respiratory
6.	Gastrointestinal 
7.	Genitourinary
8.	Musculoskeletal
9.	Integumentary (skin and/or breast)
10.	Neurological
11.	Psychiatric
12.	Endocrine
13.	Hematologic/Lymphatic
14.	Allergic/Immunologic
Identify, perform and documentation of all pertinent ROS systems with either a “positive or negative” response is necessary to be counted.
C.	The PMFSH consists of a review of four areas (NOTE:  Employers should not have access to any patient’s or the family’s generic/hereditary diagnoses or testing information, etc.)
1.	Past history – the patient’s past experiences with illnesses, operations, injuries and treatments;
2.	Family history – a review of medical events in the patient’s family, including diseases which may be hereditary or place the patient at risk and any family situations that can interfere with or support the injured worker’s treatment plan and returning to work;
3.	Occupational/Social History/Military – an age appropriate review of past and current work activities, occupational history, current work status, any work situations that support or interfere with return to work.  For established visits specific updates of progress must be discussed.
4.	Non-Occupational/Social History – Hobbies, current recreational physical activities and the patient’s support relationships, etc.  For established visits specific updates of progress must be discussed.

1.	Pertinent Physician’s Examination Component – Each bullet is counted only when it is pertinent and related to the workers’ compensation injury and the medical decision making process.
Content and Documentation Requirements
Level of Examination
Performed and Documented	# of Bullets Required for each Level	
Problem Focused	1 to 5 elements identified by a bullet as indicated in this guideline	
Expanded Problem Focused	6 elements identified by a bullet as indicated in this guideline	
Detailed	7-12 elements identified by a bullet as indicated in this guideline	
Comprehensive	> 13 elements identified by a bullet as indicated in this guideline	
Constitutional Measurement
Vital signs (may be measured and recorded by ancillary staff) – any of three vital signs is counted as one bullet:
1.	sitting or standing blood pressure
2.	supine blood pressure
3.	pulse rate and regularity
4.	respiration
5.	temperature
6.	height
7.	weight or BMI
One bullet for commenting on the general appearance of patient (e.g., development, nutrition, body habitus, deformities, attention to grooming)
Musculoskeletal
Each of the six body areas with three (3) assessments is counted as one bullet.
1.	head and or neck
2.	spine or ribs and pelvis or all three
3.	right upper extremity (shoulder, elbow, wrist, entire hand)
4.	left upper extremity (shoulder, elbow, wrist, entire hand)
5.	right lower extremity (hip, knee, ankle, entire foot)
6.	left lower extremity (hip, knee, ankle, entire foot)

Assessment of a given body area includes:
1.	Inspection, percussion and/or palpation with notation of any misalignment, asymmetry, crepitation, defects, tenderness, masses or effusions
2.	Assessment of range of motion with notation of any pain (e.g., straight leg raising), crepitation or contracture
3.	Assessment of stability with notation of any dislocation (luxation), subluxation or laxity
4.	Assessment of muscle strength and tone (e.g., flaccid, cog wheel, spastic) with notation of any atrophy or abnormal movements (fasciculation, tardive dyskinesia)
7.	Examination of gait and station
8.	Inspection and/or palpation of digits and nails (eg, clubbing, cyanosis, inflammatory conditions, petechiae, ischemia, infections, nodes.
Neck – one bullet for both examinations
1.	Examination of neck (e.g., masses, overall appearance, symmetry, tracheal position, crepitus)
2.	Examination of thyroid (e.g., enlargement, tenderness, mass)
Neurological
One bullet for each neurological examination/assessment(s) per extremity:
1.	Test coordination (e.g., finger/nose, heel/knee/shin, rapid alternating movements in the upper and lower extremities
2.	Examination of deep tendon reflexes and/or nerve stretch test with notation of pathological reflexes (e.g., Babinski)
3.	Examination of sensation (e.g., by touch, pin, vibration, proprioception)
4.	One bullet for all of the 12 cranial nerves assessments with notations of any deficits
Cardiovascular
1.	One bullet per extremity examination/assessment of peripheral vascular system by:
a.	Observation (e.g., swelling, varicosities); and
b.	Palpation (e.g., pulses, temperature, edema, tenderness)
2.	One bullet for palpation of heart (e.g., location, size, thrills)
3.	One bullet for auscultation of heart with notation of abnormal sounds and murmurs
4.	One bullet for examination of each one of the following:
a.	carotid arteries (e.g., pulse amplitude, bruits)
b.	abdominal aorta (e.g., size, bruits)
c.	femoral arteries (e.g., pulse amplitude, bruits)
Skin
One bullet for pertinent body part(s) inspection and/or palpation of skin and subcutaneous tissue (e.g., scars, rashes, lesions, cafeau-lait pots, ulcers)
Respiratory (one bullet for each examination/assessment)
1.	Assessment of respiratory effort (e.g., intercostal retractions, use of accessory muscles, diaphragmatic movement)
2.	Percussion of chest (e.g., dullness, flatness, hyperresonance)
3.	Palpation of chest (e.g., tactile fremitus)
4.	Auscultation of lungs (e.g., breath sounds, adventitious sounds, rubs)
Gastrointestinal (one bullet for each examination /assessment)
1.	Examination of abdomen with notation of presence of masses or tenderness and liver and spleen
2.	Examination of presence or absence of hernia
3.	Examination (when indicated) of anus, perineum and rectum, including sphincter tone, present of hemorrhoids, rectal masses and/or obtain stool sample of occult blood test when indicated
Psychiatric
1.	One bullet for assessment of mood and affect (e.g., depression, anxiety, agitation) if not counted under the Neurological system
2.	One bullet for a mental status examination which includes:
a.	Attention span and concentration; and
b.	Language (e.g., naming objects, repeating phrases, spontaneous speech) orientation to time, place and person; and
c.	Recent and remote memory; and
d.	Fund of knowledge (e.g., awareness of current events, past history, vocabulary)
Eyes (one bullet for both eyes and all three examinations/assessments)
1.	Inspection of conjunctivae and lids; and
2.	Examination of pupils and irises (e.g., reaction of light and accommodation, size and symmetry); and
3.	Opthalmoscopic examination of optic discs (e.g., size, C/D ratio, appearance) and posterior segments (e.g., vessel changes, exudates, hemorrhages)
Ears and Nose, Mouth and Throat
One bullet for all of the following examination/assessment:
1.	External inspection of ears and nose (e.g., overall appearance, scars, lesions, asses)
2.	Otoscopic examination of external auditory canals and tympanic membranes
3.	Assessment of hearing with tuning fork and clinical speech reception thresholds (e.g., whispered voice, finger rub, tuning fork)
One bullet for all of the following examinations/assessments:
1.	Inspection of nasal mucosa, septum and turbinates
2.	Inspection of lips, teeth and gums
3.	Examination of oropharynx:  oral mucosa, salivary glands, hard and soft palates, tongue, tonsils and posterior pharynx (e.g., asymmetry, lesions, hydration of mucosal surfaces)
Genitourinary
	MALE – 
	One bullet for each of the following examination of the male genitalia:
1.	The scrotal contents (e.g., hydrocele, spermatocele, tenderness of cord, testicular mass)
2.	Epididymides (e.g., size, symmetry, masses)
3.	Testes (e.g., size symmetry, masses)
4.	Urethral meatus (e.g., size location, lesions, discharge)
5.	Examination of the penis (e.g., lesions, presence of absence of foreskin, foreskin retract ability, plaque, masses, scarring, deformities)
6.	Digital rectal examination of prostate gland (e.g., size, symmetry, nodularity, tenderness)
7.	Inspection of anus and perineum
	FEMALE –
	One bullet for each of the following female pelvic examination(s) (with or without specimen collection for smears and cultures):
1.	Examination of external genitalia (e.g., general appearance, hair distribution, lesions) and vagina (e.g., general appearance, estrogen effect, discharge, lesions, pelvic support, cystocele rectocele)
2.	Examination of urethra (e.g., masses, tenderness, scarring)
3.	Examination of bladder (e.g., fullness, masses, tenderness)
4.	Cervix (e.g., general appearance, lesions, discharge)
5.	Uterus (e.g., size, contour, position, mobility, tenderness, consistency, descent or support)
6.	Adnexa/parametria (e.g., masses, tenderness, organomegaly, nodularity)
Chest (one bullet for both examinations/assessments of both breasts)
1.	Inspection of breasts (e.g., symmetry, nipple discharge); and
2.	Palpation of breasts and axillae (e.g., masses or lumps, tenderness)
Lymphatic palpation of lymph nodes -- two or more areas is counted as one bullet:
1.	Neck
2.	Axillae
3.	Groin
4.	Other
3.	Medical Decision Making (MDM) Component
Documentation must be patient specific and pertain directly to the current visit.  Information copied directly from prior records without change is not considered current nor counted.

Level of Risk	1.  # of Points for the # of Dxs and Management Options)	2.  # of Points for Amount and Complexity of Data)	3.  Level of Risk	
Straightforward	0-1	0-1	Minimal	
Low	2	2	Low	
Moderate	3	3	Moderate	
High	4+	4+	High	
Overall MDM is determined by the highest 2 out of the 3 above categories.

1.  Number of Diagnosis & Management Options	
Category of Problem(s)	Occurrence of Problem(s)		Value		TOTAL	
Self-limited or minor problem	(max 2)	X	1	=		
Established problem, stable or improved		X	1	=		
Established problem, minor worsening		X	2	=		
New problem with no additional workup planned or established patient with worsening of condition and no additional workup planned	(max1)	X	3	=		
New problem, additional workup planned or established patient with worsening of condition and additional workup planned.		X	4	=		

2.  Amount and/or Complexity of Data Reviewed		
Date Type:	Points	
Lab(s) ordered and/or reports reviewed	1	
X-ray(s) ordered and/or reports reviewed	1	
Discussion of test results with performing physician	1	
Decision to obtain old records and/or obtain history from someone other than the patient	1	
Medicine section (90701-99199) ordered and/or physical therapy reports reviewed and commented on progress (state whether the patient is progressing and how they are functionally progressing or not and document any planned changes to the plan of care)	2	
Review and summary of old records and/or discussion with other health provider	2	
Independent visualization of images, tracing or specimen	2	
TOTAL		

3.  Table of Risk (the highest one in any one category determines the overall risk for this portion)	
Level of Risk	Presenting Problem(s)	Diagnostic Procedure(s) Ordered	Management Option(s) Selected	
Minimal	One self-limited or minor problem, e.g., cold, insect bite, tinea corpori, minor non-sutured laceration	Lab tests requiring venipuncture
Chest x-rays
EKG/EEG
Urinalysis
Ultrasound
KOH prep	Rest
Gargles
Elastic bandages
Superficial dressings	
Low	Two or more self-limited or minor problems
One stable chronic illness, e.g., well-controlled HTN, NIDDM, cataract, BPH
Acute, uncomplicated illness or injury, e.g., allergic rhinitis or simple sprain cyctitis 
Acute laceration repair	Physiologic tests nor under stress, e.g., PFTs
Non-cardiovascular imaging studies w/contrast, e.g., barium enema
Superficial needle biopsies
Lab tests requiring arterial puncture
Skin biopsies	Over-the-counter drugs
Minor surgery w/no identified risk factors
PT/OT
IV fluids w/o additives
Simple or layered closure
Vaccine injection	
Moderate	One of more chronic illnesses with mild exacerabation, progression or side effects of treatment
Two or more stable chronic illnesses
Undiagnosed new problem with uncertain prognosis, e.g., new extremity neurologic complaints
Acute illness with systemic symptoms, e.g., pyelonephritis, colitis
Acute complicated injury, e.g., head injury with brief loss of consciousness	Physiologic tests under stress, e.g. cardiac stress test, 
Discography, stress tests
Diagnostic injections  
Deep needle or incisional biopsies
Cardiovascular imaging studies with contrast and no identified risk factors e.g. arteriogram, cardiac cath
Obtain fluid from body cavity, e.g. lumbar puncture, thoracentesis, culdocentesis
	Minor surgery with identified risk factors
Elective major surgery (open, percutaneous, or endoscopic) with no identified risk factors
Prescription drug management 
Therapeutic nuclear medicine IV fluids with additives
Closed Tx of Fx or dislocation w/o manipulation
Inability to return the injured worker to work and requires detailed functional improvement plan.	
High	One or more chronic illness with severe exacerbation, progression or side effects of treatment
Acute or chronic illnesses or injuries that pose a threat to life or bodily function, e.g., multiple trauma, acute MI, severe respiratory distress, progressive severe rheumatoid arthritis, psychiatric illness with potential threat to self or others;
An abrupt change in neurological status, e.g., seizure, TIA, weakness, sensory loss	Cardiovascular imaging studies with contrast with identified risk factors
Cardiac electrophysiological tests
Diagnostic endoscopies with identified risk factors	Elective major surgery with identified risk factors
Emergency major surgery
Parenteral controlled substances
Drug therapy requiring intensive monitoring for toxicity
Decision not to resuscitate or to de-escalate care because of poor prognosis,
Potential for significant permanent work restrictions or total disability
Management of addiction behavior or other significant psychiatric condition
Treatment plan for patients with symptoms causing severe functional deficits without supporting physiological \findings or verified related medical diagnosis.	

If greater than fifty percent of a physician’s time at an E&M visit is spent either face-to-face with the patient counseling and/or coordination of care and there is detailed patient specific documentation of the counseling and/or coordination of care, then time can determine the level of service.
The total time spent face-to-face with the patient and/or coordination of care must be documented in the record and the total visit time.
If time is used to establish the level of visit and total amount of time falls in between two levels, then the provider’s time shall be more than half way to reaching the higher level.
Documentation must be patient specific and pertain directly to the current visit.  Information copied directly from prior records without change is not considered current nor counted.
Counseling:
Primary care physicians should have shared decision making conferences with their patients to establish viable functional goals prior to making referrals for diagnostic testing and/or to specialists.  Shared decision making occurs when the physician shares with the patient all the treatment alternatives reflected in the Colorado Medical Treatment Guidelines as well as any possible side effects or limitations, and the patient shares with the primary physician their desired outcome from the treatment.  Patients should be encouraged to express their goals, outcome expectations and desires from treatment as well as any personal habits or traits that may be impacted by procedures or their possible side effects.  
The physician’s time spent face-to-face with the patient and/or their family counseling him/her or them in one or more of the following:
1.	Injury/disease education that includes discussion of diagnostic tests results and a disease specific treatment plan.
2.	Return to work
3.	Temporary and/or permanent restrictions
4.	Self-management of symptoms while at home and/or work
5.	Correct posture/mechanics to perform work functions
6.	Job task exercises for muscle strengthening and stretching
7.	Appropriate tool and equipment use to prevent re-injury and/or worsening of the existing injury/condition
8.	Patient/injured worker expectations and specific goals
9.	Family and other interpersonal relationships and how they relate to psychological/social issues
10.	Discussion of pharmaceutical management (includes drug dosage, specific drug side effects and potential of addiction /problems
11.	Assessment of vocational plans (i.e., restrictions as they relate to current and future employment job requirements)
Coordination of Care:
Coordination of care requires the physician to either call another health care provider (outside of their own clinic) regarding the patient’s diagnosis and/or treatment or the physician telephones or visits the employer in person to safely return the patient to work.
The counseling or coordination of care activities must be done 24 hours prior to the actual patient encounter or within seven (7) business days after the actual patient encounter.  If these activities are done outside of the 24 hours prior to or 7 business days after the patient encounter, then Rule 18-5(I)(4) “Treating Physician Telephone or On-line Services” or Rule 18-6(A) “Face-to-Face or Telephonic meeting by a Treating Physician with the Employer … With or Without the Injured Workers” is applicable.

Exhibit # 6
Dental Fee Schedule
Effective January 1, 2016 

CDT 2015	2016 Fees	
D0120	$67.15	
D0140	$112.29	
D0145	$104.19	
D0150	$118.08	
D0160	$237.31	
D0170	$78.72	
D0171	$71.25	
D0180	$128.50	
D0190	$62.00	
D0191	$44.00	
D0210	$187.18	
D0220	$37.68	
D0230	$34.03	
D0240	$58.35	
D0250	$71.72	
D0260	$65.64	
D0270	$38.89	
D0272	$63.21	
D0273	$76.58	
D0274	$88.74	
D0277	$133.71	
D0290	$218.79	
D0310	$556.70	
D0320	$948.10	
D0321	BR	
D0322	$765.77	
D0330	$165.54	
D0340	$186.38	
D0350	$89.13	
D0351	$73.75	
D0362	$853.17	
D0364	$1,251.00	
D0365	$1,251.00	
D0366	$1,251.00	
D0367	$1,251.00	
D0368	$1,831.00	
D0369	$3,274.00	
D0370	$1,102.00	
D0371	BR	
D0380	    $998.00	
D0381	$998.00	
D0382	$998.00	
D0383	$998.00	
D0384	$1,459.00	
D0385	$2,382.00	
D0386	$596.00	
D0391	BR	
D0393	BR	
D0394	BR	
D0395	BR	
D0415	       $72.00	
D0416	$106.00	
D0417	$97.00	
D0418	$100.00	
D0421	$72.00	
D0425	$62.00	
D0431	$100.00	
D0460	$100.00	
D0470	$219.00	
D0472	$137.00	
D0473	$290.00	
D0474	$325.00	
D0475	$175.00	
D0476	$170.00	
D0477	$232.00	
D0478	$212.00	
D0479	$325.00	
D0480	$200.00	
D0481	$858.14	
D0482	$250.00	
D0483	$250.00	
D0484	$375.00	
D0485	$517.00	
D0486	$240.00	
D0502	BR	
D0601	       $93.00	
D0602	       $93.00	
D0603	       $93.00	
D0999	BR	
D1110	     $120.33	
D1120	$83.87	
D1206	$72.93	
D1208	$45.15	
D1310	$70.61	
D1320	$77.56	
D1330	$97.24	
D1351	$78.72	
D1352	$94.50	
D1353	$80.75	
D1510	$503.57	
D1515	$704.99	
D1520	$554.51	
D1525	$856.64	
D1550	$108.82	
D1555	$104.19	
D1999	BR	
D2140	$262.55	
D2150	$339.13	
D2160	$410.84	
D2161	$500.79	
D2330	$239.45	
D2331	$306.31	
D2332	$374.38	
D2335	$443.66	
D2390	$491.06	
D2391	$280.78	
D2392	$368.30	
D2393	$457.03	
D2394	$560.35	
D2410	$457.26	
D2420	$762.88	
D2430	$1,322.01	
D2510	$1,209.72	
D2520	$1,372.95	
D2530	$1,582.48	
D2542	$1,551.22	
D2543	$1,623.00	
D2544	$1,687.82	
D2610	$1,423.88	
D2620	$1,502.60	
D2630	$1,601.00	
D2642	$1,555.85	
D2643	$1,677.40	
D2644	$1,779.27	
D2650	$935.36	
D2651	$1,114.80	
D2652	$1,171.52	
D2662	$1,016.40	
D2663	$1,195.82	
D2664	$1,281.49	
D2710	$628.41	
D2712	$628.41	
D2720	$1,548.55	
D2721	$1,451.31	
D2722	$1,482.92	
D2740	$1,588.67	
D2750	$1,568.01	
D2751	$1,459.83	
D2752	$1,495.07	
D2780	$1,503.58	
D2781	$1,414.85	
D2782	$1,461.04	
D2783	$1,546.13	
D2790	$1,512.09	
D2791	$1,433.08	
D2792	$1,459.83	
D2794	$1,548.55	
D2799	$628.41	
D2910	$143.43	
D2915	$143.43	
D2920	$144.65	
D2921	$179.50	
D2929	$543.00	
D2930	$395.04	
D2931	$447.31	
D2932	$476.48	
D2933	$545.76	
D2934	$545.76	
D2940	$150.73	
D2941	$130.00	
D2949	$130.00	
D2950	$376.80	
D2951	$85.08	
D2952	$595.60	
D2953	$297.80	
D2954	$476.48	
D2955	$367.08	
D2957	$238.23	
D2960	$1,152.30	
D2961	$1,306.67	
D2962	$1,419.72	
D2970	$357.36	
D2971	$228.51	
D2975	$695.27	
D2980	BR	
D2981	BR	
D2982	BR	
D2983	BR	
D2990	$94.00	
D2999	BR	
D3110	     $131.25	
D3120	$105.35	
D3220	$268.80	
D3221	$295.20	
D3222	$273.20	
D3230	$307.52	
D3240	$379.24	
D3310	$1,207.00	
D3320	$1,479.27	
D3330	$1,834.20	
D3331	$472.84	
D3332	$899.47	
D3333	$414.49	
D3346	$1,609.34	
D3347	$1,893.76	
D3348	$2,343.50	
D3351	$968.76	
D3352	$433.93	
D3353	  $1,335.84	
D3355	$577.25	
D3356	     $259.00	
D3357	BR	
D3410	  $1,920.50	
D3421	  $2,138.07	
D3425	$2,421.29	
D3426	  $818.03	
D3427	$1035.75	
D3428	$1509.25	
D3429	$1439.50	
D3430	$601.67	
D3431	$1772.25	
D3432	$1523.50	
D3450	$1,251.97	
D3460	$4,676.05	
D3470	$2,388.47	
D3910	$334.27	
D3920	$951.74	
D3950	$433.93	
D3999	BR	
D4210	  $1,603.00	
D4211	$712.00	
D4212	$570.00	
D4230	$2,244.00	
D4231	$1,096.39	
D4240	$2,030.00	
D4241	$1,175.00	
D4245	$1,496.00	
D4249	$2,226.00	
D4260	$3,383.00	
D4261	$1,816.00	
D4263	$1,211.00	
D4264	$1,033.00	
D4265	BR	
D4266	  $1,247.00	
D4267	$1,603.00	
D4268	BR	
D4270	  $2,404.00	
D4273	$2,938.00	
D4274	$1,667.00	
D4275	$2,208.00	
D4276	$3,294.00	
D4277	$2,493.00	
D4278	$819.00	
D4320	$625.99	
D4321	$633.28	
D4341	$361.00	
D4342	$217.57	
D4355	$246.75	
D4381	BR	
D4910	     $222.44	
D4920	$161.66	
D4921	BR	
D4999	BR	
D5110	$2,343.00	
D5120	$2,343.00	
D5130	$2,555.00	
D5140	$2,555.00	
D5211	$1,977.00	
D5212	$2,298.00	
D5213	$2,771.36	
D5214	$2,589.00	
D5225	$1,977.00	
D5226	$2,298.00	
D5281	$1,509.00	
D5410	$128.00	
D5411	$128.00	
D5421	$128.00	
D5422	$128.00	
D5510	$274.70	
D5520	$214.00	
D5610	$278.00	
D5620	$316.03	
D5630	$363.00	
D5640	$235.00	
D5650	$321.00	
D5660	$385.00	
D5670	$1,006.44	
D5671	$1,006.44	
D5710	$951.00	
D5711	$909.00	
D5720	$898.00	
D5721	$898.00	
D5730	$537.00	
D5731	$537.00	
D5740	$492.00	
D5741	$492.00	
D5750	$716.00	
D5751	$716.00	
D5760	$705.00	
D5761	$705.00	
D5810	$1,133.00	
D5811	$1,218.00	
D5820	$876.00	
D5821	$930.00	
D5850	$224.00	
D5851	$224.00	
D5862	BR	
D5863	   $2295.25	
D5864	BR	
D5865	   $2295.25	
D5866	   $3146.25	
D5867	BR	
D5875	BR	
D5899	BR	
D5911	     $594.00	
D5912	     $594.00	
D5913	$12,514.00	
D5914	$12,514.00	
D5915	$16,935.00	
D5916	$4,517.00	
D5919	BR	
D5922	BR	
D5923	BR	
D5924	BR	
D5925	BR	
D5926	BR	
D5927	BR	
D5928	BR	
D5929	BR	
D5931	  $6,738.00	
D5932	$12,602.00	
D5933	BR	
D5934	$11,486.00	
D5935	$9,994.00	
D5936	$11,225.00	
D5937	$1,411.00	
D5951	$1,834.00	
D5952	$5,956.00	
D5953	$11,310.00	
D5954	$10,481.00	
D5955	$9,694.00	
D5958	BR	
D5959	BR	
D5960	BR	
D5982	     $997.93	
D5983	  $2,416.43	
D5984	  $2,416.43	
D5985	  $2,416.43	
D5986	$214.00	
D5987	$3,627.07	
D5988	$641.00	
D5991	$246.00	
D5992	BR	
D5993	BR	
D5994	$227.50	
D5999	BR	
D6010	$3,914.00	
D6011	BR	
D6012	  $3,698.00	
D6013	   $3623.00	
D6040	$14,418.34	
D6050	$10,047.00	
D6051	BR	
D6052	  $1535.25	
D6055	 $1,176.00	
D6056	    $812.00	
D6057	 $1,005.00	
D6058	 $2,253.00	
D6059	$2,379.96	
D6060	$2,249.90	
D6061	$2,294.88	
D6062	$2,286.36	
D6063	$1,963.04	
D6064	$2,079.74	
D6065	$2,217.00	
D6066	$2,311.89	
D6067	$2,242.61	
D6068	$2,234.00	
D6069	$2,379.96	
D6070	$2,249.90	
D6071	$2,144.00	
D6072	$2,343.50	
D6073	$2,121.06	
D6074	$2,106.00	
D6075	$2,217.00	
D6076	$2,311.89	
D6077	$2,242.61	
D6080	$184.00	
D6090	BR	
D6091	$887.00	
D6092	$173.00	
D6093	$271.00	
D6094	$1,887.68	
D6095	BR	
D6100	BR	
D6101	$587.50	
D6102	$769.75	
D6103	$672.50	
D6104	     $672.50	
D6110	   $2705.00	
D6111	   $2705.00	
D6112	   $2705.00	
D6113	   $2705.00	
D6114	BR	
D6115	BR	
D6116	BR	
D6117	BR	
D6190	$395.00	
D6194	$1,817.00	
D6199	BR	
D6205	$1,016.16	
D6210	$1,553.41	
D6211	$1,454.96	
D6212	$1,514.52	
D6214	$1,563.15	
D6240	$1,533.97	
D6241	$1,416.06	
D6242	$1,493.86	
D6245	$1,582.59	
D6250	$1,514.52	
D6251	$1,396.62	
D6252	$1,441.59	
D6253	$652.72	
D6545	$610.19	
D6548	     $651.00	
D6549	$377.21	
D6600	$1,186.33	
D6601	$1,266.56	
D6602	$1,294.51	
D6603	$1,424.58	
D6604	$1,268.99	
D6605	$1,344.35	
D6606	$1,248.32	
D6607	$1,385.67	
D6608	$1,277.00	
D6609	$1,355.29	
D6610	$1,396.62	
D6611	$1,527.89	
D6612	$1,389.33	
D6613	$1,452.53	
D6614	$1,358.93	
D6615	$1,413.64	
D6624	$1,294.51	
D6634	$1,358.93	
D6710	$1,345.00	
D6720	$1,619.06	
D6721	$1,535.18	
D6722	$1,563.15	
D6740	$1,650.00	
D6750	$1,656.73	
D6751	$1,546.13	
D6752	$1,583.81	
D6780	$1,563.15	
D6781	$1,516.00	
D6782	$1,563.15	
D6783	$1,561.00	
D6790	$1,599.60	
D6791	$1,516.96	
D6792	$1,571.65	
D6793	$637.00	
D6794	$1,571.65	
D6920	$420.57	
D6930	$245.53	
D6940	$556.70	
D6950	$1,074.51	
D6980	BR	
D6985	$934.72	
D6999	BR	
D7111	$229.73	
D7140	$305.09	
D7210	$405.98	
D7220	$509.29	
D7230	$678.25	
D7240	$796.15	
D7241	$1,000.37	
D7250	$429.07	
D7251	$770.70	
D7260	$3,182.19	
D7261	$1,104.60	
D7270	     $828.45	
D7272	$1,104.60	
D7280	     $772.80	
D7282	$386.40	
D7283	$331.80	
D7285	$1,546.65	
D7286	$662.55	
D7287	$265.65	
D7288	$265.65	
D7290	$662.55	
D7291	$466.76	
D7292	$1,060.50	
D7293	$662.55	
D7294	$552.30	
D7295	BR	
D7310	$1,009.00	
D7311	$883.00	
D7320	$1,640.00	
D7321	$1,388.00	
D7340	$6,938.00	
D7350	$20,182.00	
D7410	$3,027.00	
D7411	$4,793.00	
D7412	$5,298.00	
D7413	$3,532.00	
D7414	$5,298.00	
D7415	$5,928.00	
D7440	$4,793.00	
D7441	  $7,064.00	
D7450	$3,027.00	
D7451	$4,137.00	
D7460	$3,027.00	
D7461	$4,137.00	
D7465	$1,640.00	
D7471	$3,749.00	
D7472	$4,455.00	
D7473	$4,203.00	
D7485	$3,749.00	
D7490	$30,273.00	
D7510	$1,085.00	
D7511	$1,640.00	
D7520	$5,167.00	
D7521	$5,676.00	
D7530	$1,862.00	
D7540	$2,064.00	
D7550	$1,287.00	
D7560	$10,217.00	
D7610	$16,524.00	
D7620	$12,392.00	
D7630	$21,484.00	
D7640	$13,633.00	
D7650	$10,328.00	
D7660	$6,090.00	
D7670	$4,753.00	
D7671	$8,956.00	
D7680	$30,984.00	
D7710	$19,420.00	
D7720	$13,633.00	
D7730	$28,093.00	
D7740	$13,900.00	
D7750	$17,679.00	
D7760	$7,094.00	
D7770	$9,612.00	
D7771	$7,417.00	
D7780	$41,313.00	
D7810	$18,174.00	
D7820	$2,977.00	
D7830	$1,705.00	
D7840	$24,773.00	
D7850	$21,393.00	
D7852	$24,496.00	
D7854	$25,278.00	
D7856	$17,937.00	
D7858	$51,126.00	
D7860	$21,792.00	
D7865	$35,117.00	
D7870	$1,160.00	
D7871	$2,321.00	
D7872	$12,387.00	
D7873	$14,914.00	
D7874	$21,393.00	
D7875	$23,436.00	
D7876	$25,268.00	
D7877	$22,301.00	
D7880	$2,785.00	
D7899	BR	
D7910	$1,655.00	
D7911	$4,132.00	
D7912	$7,437.00	
D7920	$12,185.00	
D7921	$1,125.00	
D7940	BR	
D7941	$31,030.00	
D7943	$28,507.00	
D7944	$25,404.00	
D7945	$33,805.00	
D7946	$41,878.00	
D7947	$35,218.00	
D7948	$45,712.00	
D7949	$59,537.00	
D7950	BR	
D7951	BR	
D7952	BR	
D7953	$858.00	
D7955	BR	
D7960	  $1,388.00	
D7963	$2,270.00	
D7970	$2,018.00	
D7971	$757.00	
D7972	$2,825.00	
D7980	$3,179.00	
D7981	BR	
D7982	$7,518.00	
D7983	$7,215.00	
D7990	  $6,206.00	
D7991	$15,137.00	
D7995	BR	
D7996	BR	
D7997	  $1,160.00	
D7998	$5,046.00	
D7999	BR	
D8010	BR	
D8020	BR	
D8030	BR	
D8040	BR	
D8050	BR	
D8060	BR	
D8070	BR	
D8080	BR	
D8090	BR	
D8210	BR	
D8220	BR	
D8660	     $700.13	
D8670	     $525.09	
D8680	  $1,154.73	
D8690	     $545.76	
D8691	     $512.95	
D8692	     $571.28	
D8693	     $528.75	
D8694	BR	
D8999	BR	
D9110	     $215.15	
D9120	     $243.11	
D9210	     $181.65	
D9211	     $200.55	
D9212	     $312.90	
D9215	     $150.15	
D9219	$189.25	
D9220	  $1,815.45	
D9221	     $813.75	
D9230	     $300.30	
D9241	  $1,408.05	
D9242	     $688.80	
D9248	     $437.85	
D9310	     $487.42	
D9410	     $557.92	
D9420	     $903.13	
D9430	     $151.94	
D9440	     $305.09	
D9450	     $151.94	
D9610	BR	
D9612	BR	
D9630	BR	
D9910	$103.03	
D9911	$144.70	
D9920	BR	
D9930	BR	
D9931	$226.50	
D9940	$940.80	
D9941	$307.52	
D9942	$354.24	
D9950	$560.29	
D9951	$251.20	
D9952	$1,179.62	
D9970	     $133.13	
D9971	     $171.33	
D9972	     $590.39	
D9973	$97.24	
D9974	$516.31	
D9975	     $576.00	
D9985	BR	
D9986	BR	
D9987	BR	
D9999	BR	

		

Final Exhibit #8 - Pathology Laboratory Maximum Fees	
Effective for Dates of Service on or after 1/1/2016	
	
HCPCS	Modifier	Maximum Fees 	Procedure Description 	
36415		 $                                          6.09 	Routine venipuncture	
78267		 $                                        21.72 	Breath tst attain/anal c-14	
78268		 $                                     186.07 	Breath test analysis c-14	
80047		 $                                        23.37 	Metabolic panel ionized ca	
80047	QW	 $                                        23.37 	Metabolic panel ionized ca	
80048		 $                                        23.37 	Metabolic panel total ca	
80048	QW	 $                                        23.37 	Metabolic panel total ca	
80051		 $                                        19.39 	Electrolyte panel	
80051	QW	 $                                        19.39 	Electrolyte panel	
80053		 $                                        29.17 	Comprehen metabolic panel	
80053	QW	 $                                        29.17 	Comprehen metabolic panel	
80061		 $                                        36.99 	Lipid panel	
80061	QW	 $                                        36.99 	Lipid panel	
80069		 $                                        23.99 	Renal function panel	
80069	QW	 $                                        23.99 	Renal function panel	
80074		 $                                     131.60 	Acute hepatitis panel	
80076		 $                                        22.55 	Hepatic function panel	
80150		 $                                        41.64 	Assay of amikacin	
80155		 $                                        39.08 	Drug screen quant caffeine	
80156		 $                                        40.23 	Assay carbamazepine total	
80157		 $                                        36.62 	Assay carbamazepine free	
80158		 $                                        49.88 	Assay of cyclosporine	
80159		 $                                        51.10 	Drug screen quant clozapine	
80162		 $                                        36.68 	Assay of digoxin	
80163		 $                                        36.68 	Assay of digoxin free	
80164		 $                                        37.43 	Assay dipropylacetic acid	
80165		 $                                        37.43 	Dipropylacetic acid free	
80168		 $                                        45.15 	Assay of ethosuximide	
80169		 $                                        37.94 	Drug screen quant everolimus	
80170		 $                                        45.27 	Assay of gentamicin	
80171		 $                                        36.62 	Drug screen quant gabapentin	
80173		 $                                        40.23 	Assay of haloperidol	
80175		 $                                        36.62 	Drug screen quan lamotrigine	
80176		 $                                        40.58 	Assay of lidocaine	
80177		 $                                        36.62 	Drug scrn quan levetiracetam	
80178		 $                                        18.27 	Assay of lithium	
80178	QW	 $                                        18.27 	Assay of lithium	
80180		 $                                        49.88 	Drug scrn quan mycophenolate	
80183		 $                                        36.62 	Drug scrn quant oxcarbazepin	
80184		 $                                        31.63 	Assay of phenobarbital	
80185		 $                                        36.62 	Assay of phenytoin total	
80186		 $                                        38.02 	Assay of phenytoin free	
80188		 $                                        45.84 	Assay of primidone	
80190		 $                                        46.28 	Assay of procainamide	
80192		 $                                        46.28 	Assay of procainamide	
80194		 $                                        40.34 	Assay of quinidine	
80195		 $                                        37.94 	Assay of sirolimus	
80197		 $                                        37.94 	Assay of tacrolimus	
80198		 $                                        39.08 	Assay of theophylline	
80199		 $                                        49.90 	Drug screen quant tiagabine	
80200		 $                                        44.54 	Assay of tobramycin	
80201		 $                                        32.95 	Assay of topiramate	
80202		 $                                        37.43 	Assay of vancomycin	
80203		 $                                        36.62 	Drug screen quant zonisamide	
80299		 $                                        37.84 	Quantitative assay drug	
80400		 $                                        90.11 	Acth stimulation panel	
80402		 $                                     240.21 	Acth stimulation panel	
80406		 $                                     172.55 	Acth stimulation panel	
80408		 $                                     346.68 	Aldosterone suppression eval	
80410		 $                                     221.94 	Calcitonin stimul panel	
80412		 $                                     910.60 	CRH stimulation panel	
80414		 $                                     142.65 	Testosterone response	
80415		 $                                     154.38 	Estradiol response panel	
80416		 $                                     364.55 	Renin stimulation panel	
80417		 $                                     121.52 	Renin stimulation panel	
80418		 $                                  1,601.14 	Pituitary evaluation panel	
80420		 $                                     199.02 	Dexamethasone panel	
80422		 $                                     127.28 	Glucagon tolerance panel	
80424		 $                                     139.50 	Glucagon tolerance panel	
80426		 $                                     409.98 	Gonadotropin hormone panel	
80428		 $                                     184.26 	Growth hormone panel	
80430		 $                                     216.80 	Growth hormone panel	
80432		 $                                     325.90 	Insulin suppression panel	
80434		 $                                     279.49 	Insulin tolerance panel	
80435		 $                                     284.59 	Insulin tolerance panel	
80436		 $                                     251.84 	Metyrapone panel	
80438		 $                                     139.26 	TRH stimulation panel	
80439		 $                                     185.68 	TRH stimulation panel	
81000		 $                                          8.75 	Urinalysis nonauto w/scope	
81001		 $                                          8.75 	Urinalysis auto w/scope	
81002		 $                                          7.06 	Urinalysis nonauto w/o scope	
81003		 $                                          6.21 	Urinalysis auto w/o scope	
81003	QW	 $                                          6.21 	Urinalysis auto w/o scope	
81005		 $                                          5.99 	Urinalysis	
81007		 $                                          7.08 	Urine screen for bacteria	
81007	QW	 $                                          7.08 	Urine screen for bacteria	
81015		 $                                          8.40 	Microscopic exam of urine	
81020		 $                                        10.19 	Urinalysis glass test	
81025		 $                                        17.48 	Urine pregnancy test	
81050		 $                                          8.28 	Urinalysis volume measure	
81161		 $                                              -   	Dmd dup/delet analysis	
81206		 $                                     452.95 	Bcr/abl1 gene major bp	
81207		 $                                     400.11 	Bcr/abl1 gene minor bp	
81208		 $                                     444.33 	Bcr/abl1 gene other bp	
81210		 $                                     362.96 	Braf gene	
81211		 $                                  4,421.42 	Brca1&2 seq & com dup/del	
81212		 $                                     357.81 	Brca1&2 185&5385&6174 var	
81213		 $                                  1,179.96 	Brca1&2 uncom dup/del var	
81214		 $                                  2,912.12 	Brca1 full seq & com dup/del	
81215		 $                                     188.81 	Brca1 gene known fam variant	
81217		 $                                     188.81 	Brca2 gene known fam variant	
81225		 $                                     590.87 	Cyp2c19 gene com variants	
81226		 $                                     914.43 	Cyp2d6 gene com variants	
81227		 $                                     354.52 	Cyp2c9 gene com variants	
81235		 $                                     668.24 	Egfr gene com variants	
81240		 $                                     135.93 	F2 gene	
81241		 $                                     168.81 	F5 gene	
81245		 $                                     335.99 	Flt3 gene	
81246		 $                                              -   	Flt3 gene analysis	
81256		 $                                     180.57 	Hfe gene	
81261		 $                                     546.94 	Igh gene rearrange amp meth	
81262		 $                                     120.58 	Igh gene rearrang dir probe	
81263		 $                                     813.60 	Igh vari regional mutation	
81264		 $                                     412.52 	Igk rearrangeabn clonal pop	
81265		 $                                     594.08 	Str markers specimen anal	
81267		 $                                     573.11 	Chimerism anal no cell selec	
81268		 $                                     720.43 	Chimerism anal w/cell select	
81270		 $                                     253.24 	Jak2 gene	
81275		 $                                     399.89 	Kras gene	
81287		 $                                              -   	Mgmt gene methylation anal	
81288		 $                                              -   	Mlh1 gene	
81291		 $                                     120.58 	Mthfr gene	
81292		 $                                  1,308.58 	Mlh1 gene full seq	
81293		 $                                     524.57 	Mlh1 gene known variants	
81294		 $                                     386.11 	Mlh1 gene dup/delete variant	
81295		 $                                     307.20 	Msh2 gene full seq	
81296		 $                                     262.30 	Msh2 gene known variants	
81297		 $                                     307.20 	Msh2 gene dup/delete variant	
81298		 $                                     582.83 	Msh6 gene full seq	
81299		 $                                     326.51 	Msh6 gene known variants	
81300		 $                                     327.40 	Msh6 gene dup/delete variant	
81301		 $                                     799.92 	Microsatellite instability	
81310		 $                                     500.44 	Npm1 gene	
81313		 $                                              -   	Pca3/klk3 antigen	
81315		 $                                     572.70 	Pml/raralpha com breakpoints	
81316		 $                                     873.53 	Pml/raralpha 1 breakpoint	
81317		 $                                  1,582.06 	Pms2 gene full seq analysis	
81318		 $                                     373.82 	Pms2 known familial variants	
81319		 $                                     448.85 	Pms2 gene dup/delet variants	
81321		 $                                  1,216.38 	Pten gene full sequence	
81322		 $                                     118.25 	Pten gene known fam variant	
81323		 $                                     177.38 	Pten gene dup/delet variant	
81332		 $                                     120.58 	Serpina1 gene	
81340		 $                                     577.15 	Trb@ gene rearrange amplify	
81341		 $                                     136.98 	Trb@ gene rearrange dirprobe	
81342		 $                                     556.65 	Trg gene rearrangement anal	
81370		 $                                  1,110.88 	Hla i & ii typing lr	
81371		 $                                     664.91 	Hla i & ii type verify lr	
81372		 $                                     610.24 	Hla i typing complete lr	
81373		 $                                     307.65 	Hla i typing 1 locus lr	
81374		 $                                     200.97 	Hla i typing 1 antigen lr	
81375		 $                                     609.81 	Hla ii typing ag equiv lr	
81376		 $                                     337.63 	Hla ii typing 1 locus lr	
81377		 $                                     253.63 	Hla ii type 1 ag equiv lr	
81378		 $                                     954.63 	Hla i & ii typing hr	
81379		 $                                     926.49 	Hla i typing complete hr	
81380		 $                                     489.66 	Hla i typing 1 locus hr	
81381		 $                                     261.28 	Hla i typing 1 allele hr	
81382		 $                                     341.67 	Hla ii typing 1 loc hr	
81383		 $                                     301.48 	Hla ii typing 1 allele hr	
81410		 $                                              -   	Aortic dysfunction/dilation	
81411		 $                                              -   	Aortic dysfunction/dilation	
81415		 $                                              -   	Exome sequence analysis	
81416		 $                                              -   	Exome sequence analysis	
81417		 $                                              -   	Exome re-evaluation	
81420		 $                                              -   	Fetal chrmoml aneuploidy	
81425		 $                                              -   	Genome sequence analysis	
81426		 $                                              -   	Genome sequence analysis	
81427		 $                                              -   	Genome re-evaluation	
81430		 $                                              -   	Hearing loss sequence analys	
81431		 $                                              -   	Hearing loss dup/del analys	
81435		 $                                              -   	Hereditary colon cancer	
81436		 $                                              -   	Hereditary colon ca synd	
81440		 $                                              -   	Mitochondrial gene	
81445		 $                                              -   	Targeted genomic seq analys	
81450		 $                                              -   	Targeted genomic seq analys	
81455		 $                                              -   	Targeted genomic seq analys	
81460		 $                                              -   	Whole mitochondrial genome	
81465		 $                                              -   	Whole mitochondrial genome	
81470		 $                                              -   	X-linked intellectual dblt	
81471		 $                                              -   	X-linked intellectual dblt	
82009		 $                                        12.48 	Test for acetone/ketones	
82010		 $                                        22.57 	Acetone assay	
82010	QW	 $                                        22.57 	Acetone assay	
82013		 $                                        30.86 	Acetylcholinesterase assay	
82016		 $                                        38.31 	Acylcarnitines qual	
82017		 $                                          7.29 	Acylcarnitines quant	
82024		 $                                     106.70 	Assay of acth	
82030		 $                                        39.14 	Assay of adp & amp	
82040		 $                                        13.66 	Assay of serum albumin	
82040	QW	 $                                        13.66 	Assay of serum albumin	
82042		 $                                          8.02 	Assay of urine albumin	
82042	QW	 $                                          8.02 	Assay of urine albumin	
82043		 $                                        15.98 	Microalbumin quantitative	
82043	QW	 $                                        15.98 	Microalbumin quantitative	
82044		 $                                        12.63 	Microalbumin semiquant	
82044	QW	 $                                        12.63 	Microalbumin semiquant	
82045		 $                                        90.09 	Albumin ischemia modified	
82075		 $                                        33.29 	Assay of breath ethanol	
82085		 $                                        26.82 	Assay of aldolase	
82088		 $                                     112.58 	Assay of aldosterone	
82103		 $                                        37.13 	Alpha-1-antitrypsin total	
82104		 $                                        39.95 	Alpha-1-antitrypsin pheno	
82105		 $                                        46.34 	Alpha-fetoprotein serum	
82106		 $                                        46.34 	Alpha-fetoprotein amniotic	
82107		 $                                     177.93 	Alpha-fetoprotein l3	
82108		 $                                        70.38 	Assay of aluminum	
82120		 $                                          4.77 	Amines vaginal fluid qual	
82120	QW	 $                                          4.77 	Amines vaginal fluid qual	
82127		 $                                        38.31 	Amino acid single qual	
82128		 $                                        38.31 	Amino acids mult qual	
82131		 $                                        46.59 	Amino acids single quant	
82135		 $                                        45.45 	Assay aminolevulinic acid	
82136		 $                                          7.29 	Amino acids quant 2-5	
82139		 $                                          7.29 	Amino acids quan 6 or more	
82140		 $                                        40.25 	Assay of ammonia	
82143		 $                                        18.98 	Amniotic fluid scan	
82150		 $                                        17.90 	Assay of amylase	
82150	QW	 $                                        17.90 	Assay of amylase	
82154		 $                                        41.23 	Androstanediol glucuronide	
82157		 $                                        80.88 	Assay of androstenedione	
82160		 $                                        69.08 	Assay of androsterone	
82163		 $                                        56.70 	Assay of angiotensin II	
82164		 $                                        40.34 	Angiotensin I enzyme test	
82172		 $                                        42.81 	Assay of apolipoprotein	
82175		 $                                        52.41 	Assay of arsenic	
82180		 $                                        27.30 	Assay of ascorbic acid	
82190		 $                                        41.17 	Atomic absorption	
82232		 $                                        44.70 	Assay of beta-2 protein	
82239		 $                                        23.30 	Bile acids total	
82240		 $                                        35.34 	Bile acids cholylglycine	
82247		 $                                        13.86 	Bilirubin total	
82247	QW	 $                                        13.86 	Bilirubin total	
82248		 $                                        13.86 	Bilirubin direct	
82252		 $                                          3.88 	Fecal bilirubin test	
82261		 $                                          7.29 	Assay of biotinidase	
82270		 $                                          8.99 	Occult blood feces	
82271		 $                                          8.99 	Occult blood other sources	
82271	QW	 $                                          8.99 	Occult blood other sources	
82272		 $                                          8.99 	Occult bld feces 1-3 tests	
82272	QW	 $                                          8.99 	Occult bld feces 1-3 tests	
82274		 $                                        43.95 	Assay test for blood fecal	
82274	QW	 $                                        43.95 	Assay test for blood fecal	
82286		 $                                        19.04 	Assay of bradykinin	
82300		 $                                        63.92 	Assay of cadmium	
82306		 $                                        81.79 	Vitamin d 25 hydroxy	
82308		 $                                        73.99 	Assay of calcitonin	
82310		 $                                        14.25 	Assay of calcium	
82310	QW	 $                                        14.25 	Assay of calcium	
82330		 $                                        37.76 	Assay of calcium	
82330	QW	 $                                        37.76 	Assay of calcium	
82331		 $                                        14.29 	Calcium infusion test	
82340		 $                                        16.67 	Assay of calcium in urine	
82355		 $                                        31.97 	Calculus analysis qual	
82360		 $                                        35.57 	Calculus assay quant	
82365		 $                                        35.63 	Calculus spectroscopy	
82370		 $                                        34.61 	X-ray assay calculus	
82373		 $                                        49.90 	Assay c-d transfer measure	
82374		 $                                          7.86 	Assay blood carbon dioxide	
82374	QW	 $                                          7.86 	Assay blood carbon dioxide	
82375		 $                                        34.04 	Assay carboxyhb quant	
82376		 $                                        13.76 	Assay carboxyhb qual	
82378		 $                                        52.39 	Carcinoembryonic antigen	
82379		 $                                          7.29 	Assay of carnitine	
82380		 $                                        25.48 	Assay of carotene	
82382		 $                                        47.50 	Assay urine catecholamines	
82383		 $                                        69.22 	Assay blood catecholamines	
82384		 $                                        69.75 	Assay three catecholamines	
82387		 $                                        22.33 	Assay of cathepsin-d	
82390		 $                                        29.68 	Assay of ceruloplasmin	
82397		 $                                        22.33 	Chemiluminescent assay	
82415		 $                                        35.00 	Assay of chloramphenicol	
82435		 $                                          7.69 	Assay of blood chloride	
82435	QW	 $                                          7.69 	Assay of blood chloride	
82436		 $                                        13.91 	Assay of urine chloride	
82438		 $                                        13.50 	Assay other fluid chlorides	
82441		 $                                        16.59 	Test for chlorohydrocarbons	
82465		 $                                        12.02 	Assay bld/serum cholesterol	
82465	QW	 $                                        12.02 	Assay bld/serum cholesterol	
82480		 $                                        21.76 	Assay serum cholinesterase	
82482		 $                                        21.21 	Assay rbc cholinesterase	
82485		 $                                        49.07 	Assay chondroitin sulfate	
82486		 $                                        49.90 	Gas/liquid chromatography	
82487		 $                                        44.11 	Paper chromatography	
82488		 $                                        59.01 	Paper chromatography	
82489		 $                                        51.10 	Thin layer chromatography	
82491		 $                                        49.90 	Chromotography quant sing	
82492		 $                                        49.90 	Chromotography quant mult	
82495		 $                                        56.03 	Assay of chromium	
82507		 $                                        76.82 	Assay of citrate	
82523		 $                                        51.62 	Collagen crosslinks	
82523	QW	 $                                        51.62 	Collagen crosslinks	
82525		 $                                        34.29 	Assay of copper	
82528		 $                                        62.20 	Assay of corticosterone	
82530		 $                                        46.16 	Cortisol free	
82533		 $                                        45.05 	Total cortisol	
82540		 $                                        12.81 	Assay of creatine	
82541		 $                                        49.90 	Column chromotography qual	
82542		 $                                        49.90 	Column chromotography quant	
82543		 $                                        49.90 	Column chromotograph/isotope	
82544		 $                                        49.90 	Column chromotograph/isotope	
82550		 $                                        17.99 	Assay of ck (cpk)	
82550	QW	 $                                        17.99 	Assay of ck (cpk)	
82552		 $                                        37.01 	Assay of cpk in blood	
82553		 $                                        31.91 	Creatine mb fraction	
82554		 $                                        32.78 	Creatine isoforms	
82565		 $                                        14.15 	Assay of creatinine	
82565	QW	 $                                        14.15 	Assay of creatinine	
82570		 $                                        14.29 	Assay of urine creatinine	
82570	QW	 $                                        14.29 	Assay of urine creatinine	
82575		 $                                        26.11 	Creatinine clearance test	
82585		 $                                        19.57 	Assay of cryofibrinogen	
82595		 $                                        17.88 	Assay of cryoglobulin	
82600		 $                                        53.59 	Assay of cyanide	
82607		 $                                        41.64 	Vitamin B-12	
82608		 $                                        39.54 	B-12 binding capacity	
82610		 $                                        15.65 	Cystatin c	
82615		 $                                        22.55 	Test for urine cystines	
82626		 $                                        69.81 	Dehydroepiandrosterone	
82627		 $                                        61.43 	Dehydroepiandrosterone	
82633		 $                                        85.58 	Desoxycorticosterone	
82634		 $                                        80.88 	Deoxycortisol	
82638		 $                                        33.82 	Assay of dibucaine number	
82652		 $                                     106.35 	Vit d 1 25-dihydroxy	
82656		 $                                        31.87 	Pancreatic elastase fecal	
82657		 $                                        49.90 	Enzyme cell activity	
82658		 $                                        49.90 	Enzyme cell activity ra	
82664		 $                                        94.90 	Electrophoretic test	
82668		 $                                        51.93 	Assay of erythropoietin	
82670		 $                                        77.18 	Assay of estradiol	
82671		 $                                        89.24 	Assay of estrogens	
82672		 $                                        59.95 	Assay of estrogen	
82677		 $                                        66.81 	Assay of estriol	
82679		 $                                        68.94 	Assay of estrone	
82679	QW	 $                                        68.94 	Assay of estrone	
82693		 $                                        41.15 	Assay of ethylene glycol	
82696		 $                                        65.14 	Assay of etiocholanolone	
82705		 $                                        14.07 	Fats/lipids feces qual	
82710		 $                                        46.43 	Fats/lipids feces quant	
82715		 $                                        27.47 	Assay of fecal fat	
82725		 $                                        36.78 	Assay of blood fatty acids	
82726		 $                                        49.90 	Long chain fatty acids	
82728		 $                                        37.64 	Assay of ferritin	
82731		 $                                     177.93 	Assay of fetal fibronectin	
82735		 $                                        51.22 	Assay of fluoride	
82746		 $                                        40.62 	Assay of folic acid serum	
82747		 $                                        47.54 	Assay of folic acid rbc	
82757		 $                                        21.54 	Assay of semen fructose	
82759		 $                                        43.04 	Assay of rbc galactokinase	
82760		 $                                        30.94 	Assay of galactose	
82775		 $                                        58.20 	Assay galactose transferase	
82776		 $                                        15.75 	Galactose transferase test	
82777		 $                                        60.76 	Galectin-3	
82784		 $                                        15.75 	Assay iga/igd/igg/igm each	
82785		 $                                        45.49 	Assay of ige	
82787		 $                                        12.69 	Igg 1 2 3 or 4 each	
82800		 $                                        23.37 	Blood pH	
82803		 $                                        53.45 	Blood gases any combination	
82805		 $                                        78.40 	Blood gases w/o2 saturation	
82810		 $                                        24.12 	Blood gases o2 sat only	
82820		 $                                        26.78 	Hemoglobin-oxygen affinity	
82930		 $                                        15.04 	Gastric analy w/ph ea spec	
82938		 $                                        48.88 	Gastrin test	
82941		 $                                        48.72 	Assay of gastrin	
82943		 $                                        39.46 	Assay of glucagon	
82945		 $                                        10.84 	Glucose other fluid	
82946		 $                                        36.82 	Glucagon tolerance test	
82947		 $                                        10.84 	Assay glucose blood quant	
82947	QW	 $                                        10.84 	Assay glucose blood quant	
82948		 $                                          8.75 	Reagent strip/blood glucose	
82950		 $                                        13.11 	Glucose test	
82950	QW	 $                                        13.11 	Glucose test	
82951		 $                                        17.72 	Glucose tolerance test (GTT)	
82951	QW	 $                                        17.72 	Glucose tolerance test (GTT)	
82952		 $                                        10.84 	GTT-added samples	
82952	QW	 $                                        10.84 	GTT-added samples	
82955		 $                                        26.78 	Assay of g6pd enzyme	
82960		 $                                        16.73 	Test for G6PD enzyme	
82962		 $                                          4.97 	Glucose blood test	
82963		 $                                        59.36 	Assay of glucosidase	
82965		 $                                        21.36 	Assay of gdh enzyme	
82977		 $                                        19.89 	Assay of GGT	
82977	QW	 $                                        19.89 	Assay of GGT	
82978		 $                                        29.41 	Assay of glutathione	
82979		 $                                        19.04 	Assay rbc glutathione	
82985		 $                                        41.64 	Assay of glycated protein	
82985	QW	 $                                        41.64 	Assay of glycated protein	
83001		 $                                        51.34 	Assay of gonadotropin (fsh)	
83001	QW	 $                                        51.34 	Assay of gonadotropin (fsh)	
83002		 $                                        51.16 	Assay of gonadotropin (lh)	
83002	QW	 $                                        51.16 	Assay of gonadotropin (lh)	
83003		 $                                        46.08 	Assay growth hormone (hgh)	
83006		 $                                        60.76 	Growth stimulation gene 2	
83009		 $                                     186.07 	H pylori (c-13) blood	
83010		 $                                        18.31 	Assay of haptoglobin quant	
83012		 $                                        47.50 	Assay of haptoglobins	
83013		 $                                     186.07 	H pylori (c-13) breath	
83014		 $                                        21.72 	H pylori drug admin	
83015		 $                                        52.03 	Heavy metal screen	
83018		 $                                        60.68 	Quantitative screen metals	
83020		 $                                        32.09 	Hemoglobin electrophoresis	
83021		 $                                        49.90 	Hemoglobin chromotography	
83026		 $                                          6.54 	Hemoglobin copper sulfate	
83030		 $                                        22.84 	Fetal hemoglobin chemical	
83033		 $                                        16.46 	Fetal hemoglobin assay qual	
83036		 $                                        26.82 	Glycosylated hemoglobin test	
83036	QW	 $                                        26.82 	Glycosylated hemoglobin test	
83037		 $                                        26.82 	Glycosylated hb home device	
83037	QW	 $                                        26.82 	Glycosylated hb home device	
83045		 $                                        13.68 	Blood methemoglobin test	
83050		 $                                        20.26 	Blood methemoglobin assay	
83051		 $                                          9.68 	Assay of plasma hemoglobin	
83060		 $                                        22.84 	Blood sulfhemoglobin assay	
83065		 $                                        19.04 	Assay of hemoglobin heat	
83068		 $                                        23.37 	Hemoglobin stability screen	
83069		 $                                        10.90 	Assay of urine hemoglobin	
83070		 $                                        13.11 	Assay of hemosiderin qual	
83080		 $                                          7.29 	Assay of b hexosaminidase	
83088		 $                                        81.59 	Assay of histamine	
83090		 $                                        46.59 	Assay of homocystine	
83150		 $                                        53.45 	Assay of homovanillic acid	
83491		 $                                        48.40 	Assay of corticosteroids 17	
83497		 $                                        35.63 	Assay of 5-hiaa	
83498		 $                                        75.05 	Assay of progesterone 17-d	
83499		 $                                        69.65 	Assay of progesterone 20-	
83500		 $                                        62.56 	Assay free hydroxyproline	
83505		 $                                        67.17 	Assay total hydroxyproline	
83516		 $                                        31.87 	Immunoassay nonantibody	
83516	QW	 $                                        31.87 	Immunoassay nonantibody	
83518		 $                                        23.41 	Immunoassay dipstick	
83518	QW	 $                                        23.41 	Immunoassay dipstick	
83519		 $                                        37.33 	Ria nonantibody	
83520		 $                                        35.77 	Immunoassay quant nos nonab	
83520	QW	 $                                        35.77 	Immunoassay quant nos nonab	
83525		 $                                        31.57 	Assay of insulin	
83527		 $                                        34.98 	Assay of insulin	
83528		 $                                        43.95 	Assay of intrinsic factor	
83540		 $                                        17.88 	Assay of iron	
83550		 $                                        24.16 	Iron binding test	
83570		 $                                        24.44 	Assay of idh enzyme	
83582		 $                                        39.14 	Assay of ketogenic steroids	
83586		 $                                        35.38 	Assay 17- ketosteroids	
83593		 $                                        72.65 	Fractionation ketosteroids	
83605		 $                                          3.88 	Assay of lactic acid	
83605	QW	 $                                          3.88 	Assay of lactic acid	
83615		 $                                        16.67 	Lactate (LD) (LDH) enzyme	
83625		 $                                        16.40 	Assay of ldh enzymes	
83630		 $                                        54.22 	Lactoferrin fecal (qual)	
83631		 $                                        54.22 	Lactoferrin fecal (quant)	
83632		 $                                        55.85 	Placental lactogen	
83633		 $                                        15.18 	Test urine for lactose	
83655		 $                                        33.43 	Assay of lead	
83655	QW	 $                                        33.43 	Assay of lead	
83661		 $                                        27.47 	L/s ratio fetal lung	
83662		 $                                        52.25 	Foam stability fetal lung	
83663		 $                                        52.25 	Fluoro polarize fetal lung	
83664		 $                                        52.25 	Lamellar bdy fetal lung	
83670		 $                                        25.31 	Assay of lap enzyme	
83690		 $                                        19.04 	Assay of lipase	
83695		 $                                        35.77 	Assay of lipoprotein(a)	
83698		 $                                        90.09 	Assay lipoprotein pla2	
83700		 $                                        27.30 	Lipopro bld electrophoretic	
83701		 $                                        68.57 	Lipoprotein bld hr fraction	
83704		 $                                        87.15 	Lipoprotein bld by nmr	
83718		 $                                        22.61 	Assay of lipoprotein	
83718	QW	 $                                        22.61 	Assay of lipoprotein	
83719		 $                                        32.16 	Assay of blood lipoprotein	
83721		 $                                        26.37 	Assay of blood lipoprotein	
83721	QW	 $                                        26.37 	Assay of blood lipoprotein	
83727		 $                                        47.50 	Assay of lrh hormone	
83735		 $                                        18.49 	Assay of magnesium	
83775		 $                                        20.36 	Assay malate dehydrogenase	
83785		 $                                        67.94 	Assay of manganese	
83788		 $                                        49.90 	Mass spectrometry qual	
83789		 $                                        49.90 	Mass spectrometry quant	
83825		 $                                        44.90 	Assay of mercury	
83835		 $                                        46.79 	Assay of metanephrines	
83857		 $                                        29.68 	Assay of methemalbumin	
83861		 $                                        45.63 	Microfluid analy tears	
83861	QW	 $                                        45.63 	Microfluid analy tears	
83864		 $                                        55.01 	Mucopolysaccharides	
83872		 $                                        16.20 	Assay synovial fluid mucin	
83873		 $                                        47.52 	Assay of csf protein	
83874		 $                                        35.69 	Assay of myoglobin	
83876		 $                                        90.09 	Assay myeloperoxidase	
83880		 $                                        90.09 	Assay of natriuretic peptide	
83880	QW	 $                                        90.09 	Assay of natriuretic peptide	
83883		 $                                        15.65 	Assay nephelometry not spec	
83885		 $                                        67.68 	Assay of nickel	
83915		 $                                        30.82 	Assay of nucleotidase	
83916		 $                                        55.56 	Oligoclonal bands	
83918		 $                                        45.45 	Organic acids total quant	
83919		 $                                        45.45 	Organic acids qual each	
83921		 $                                        45.45 	Organic acid single quant	
83930		 $                                        18.27 	Assay of blood osmolality	
83935		 $                                        18.84 	Assay of urine osmolality	
83937		 $                                        41.23 	Assay of osteocalcin	
83945		 $                                        35.57 	Assay of oxalate	
83950		 $                                     177.93 	Oncoprotein her-2/neu	
83951		 $                                     177.93 	Oncoprotein dcp	
83970		 $                                     114.03 	Assay of parathormone	
83986		 $                                          9.89 	Assay ph body fluid nos	
83986	QW	 $                                          9.89 	Assay ph body fluid nos	
83987		 $                                        43.87 	Exhaled breath condensate	
83992		 $                                        40.60 	Assay for phencyclidine	
83993		 $                                        54.22 	Assay for calprotectin fecal	
84030		 $                                        15.18 	Assay of blood pku	
84035		 $                                          8.47 	Assay of phenylketones	
84060		 $                                        20.40 	Assay acid phosphatase	
84061		 $                                        21.84 	Phosphatase forensic exam	
84066		 $                                        26.69 	Assay prostate phosphatase	
84075		 $                                        14.29 	Assay alkaline phosphatase	
84075	QW	 $                                        14.29 	Assay alkaline phosphatase	
84078		 $                                        20.18 	Assay alkaline phosphatase	
84080		 $                                        40.84 	Assay alkaline phosphatases	
84081		 $                                        45.63 	Assay phosphatidylglycerol	
84085		 $                                        18.64 	Assay of rbc pg6d enzyme	
84087		 $                                        28.52 	Assay phosphohexose enzymes	
84100		 $                                        13.09 	Assay of phosphorus	
84105		 $                                        14.29 	Assay of urine phosphorus	
84106		 $                                        11.73 	Test for porphobilinogen	
84110		 $                                        23.30 	Assay of porphobilinogen	
84112		 $                                     177.93 	Placenta alpha micro ig c/v	
84119		 $                                        23.79 	Test urine for porphyrins	
84120		 $                                        40.64 	Assay of urine porphyrins	
84126		 $                                        70.36 	Assay of feces porphyrins	
84132		 $                                        12.71 	Assay of serum potassium	
84132	QW	 $                                        12.71 	Assay of serum potassium	
84133		 $                                        11.88 	Assay of urine potassium	
84134		 $                                        15.65 	Assay of prealbumin	
84135		 $                                        52.84 	Assay of pregnanediol	
84138		 $                                        52.31 	Assay of pregnanetriol	
84140		 $                                        41.23 	Assay of pregnenolone	
84143		 $                                        41.23 	Assay of 17-hydroxypregneno	
84144		 $                                        43.04 	Assay of progesterone	
84145		 $                                        73.99 	Procalcitonin (pct)	
84146		 $                                        53.53 	Assay of prolactin	
84150		 $                                        68.94 	Assay of prostaglandin	
84152		 $                                        50.81 	Assay of psa complexed	
84153		 $                                        50.81 	Assay of psa total	
84154		 $                                        50.81 	Assay of psa free	
84155		 $                                        10.13 	Assay of protein serum	
84155	QW	 $                                        10.13 	Assay of protein serum	
84156		 $                                        10.13 	Assay of protein urine	
84157		 $                                        10.13 	Assay of protein other	
84157	QW	 $                                        10.13 	Assay of protein other	
84160		 $                                        14.29 	Assay of protein any source	
84163		 $                                        41.59 	Pappa serum	
84165		 $                                        29.66 	Protein e-phoresis serum	
84166		 $                                        49.27 	Protein e-phoresis/urine/csf	
84181		 $                                        47.06 	Western blot test	
84182		 $                                        49.71 	Protein western blot test	
84202		 $                                        39.63 	Assay RBC protoporphyrin	
84203		 $                                        23.77 	Test RBC protoporphyrin	
84206		 $                                        49.07 	Assay of proinsulin	
84207		 $                                        77.63 	Assay of vitamin b-6	
84210		 $                                        29.98 	Assay of pyruvate	
84220		 $                                        26.09 	Assay of pyruvate kinase	
84228		 $                                        32.16 	Assay of quinine	
84233		 $                                     177.93 	Assay of estrogen	
84234		 $                                     179.23 	Assay of progesterone	
84235		 $                                     144.60 	Assay of endocrine hormone	
84238		 $                                     101.03 	Assay nonendocrine receptor	
84244		 $                                        60.76 	Assay of renin	
84252		 $                                        55.91 	Assay of vitamin b-2	
84255		 $                                        70.52 	Assay of selenium	
84260		 $                                        51.36 	Assay of serotonin	
84270		 $                                        60.05 	Assay of sex hormone globul	
84275		 $                                        37.13 	Assay of sialic acid	
84285		 $                                        65.04 	Assay of silica	
84295		 $                                        13.30 	Assay of serum sodium	
84295	QW	 $                                        13.30 	Assay of serum sodium	
84300		 $                                        13.44 	Assay of urine sodium	
84302		 $                                        13.44 	Assay of sweat sodium	
84305		 $                                        54.24 	Assay of somatomedin	
84307		 $                                        50.51 	Assay of somatostatin	
84311		 $                                        19.33 	Spectrophotometry	
84315		 $                                          6.94 	Body fluid specific gravity	
84375		 $                                          6.62 	Chromatogram assay sugars	
84376		 $                                        15.18 	Sugars single qual	
84377		 $                                        15.18 	Sugars multiple qual	
84378		 $                                        31.85 	Sugars single quant	
84379		 $                                        31.85 	Sugars multiple quant	
84392		 $                                        13.11 	Assay of urine sulfate	
84402		 $                                        70.34 	Assay of free testosterone	
84403		 $                                        71.31 	Assay of total testosterone	
84425		 $                                        58.65 	Assay of vitamin b-1	
84430		 $                                        32.16 	Assay of thiocyanate	
84431		 $                                        46.43 	Thromboxane urine	
84432		 $                                        42.22 	Assay of thyroglobulin	
84436		 $                                        18.98 	Assay of total thyroxine	
84437		 $                                        17.88 	Assay of neonatal thyroxine	
84439		 $                                        22.51 	Assay of free thyroxine	
84442		 $                                        32.09 	Assay of thyroid activity	
84443		 $                                        46.43 	Assay thyroid stim hormone	
84443	QW	 $                                        46.43 	Assay thyroid stim hormone	
84445		 $                                     140.48 	Assay of tsi globulin	
84446		 $                                        39.16 	Assay of vitamin e	
84449		 $                                        41.23 	Assay of transcortin	
84450		 $                                        14.29 	Transferase (AST) (SGOT)	
84450	QW	 $                                        14.29 	Transferase (AST) (SGOT)	
84460		 $                                        14.64 	Alanine amino (ALT) (SGPT)	
84460	QW	 $                                        14.64 	Alanine amino (ALT) (SGPT)	
84466		 $                                        35.28 	Assay of transferrin	
84478		 $                                        15.87 	Assay of triglycerides	
84478	QW	 $                                        15.87 	Assay of triglycerides	
84479		 $                                        17.88 	Assay of thyroid (t3 or t4)	
84480		 $                                        39.16 	Assay triiodothyronine (t3)	
84481		 $                                        46.79 	Free assay (FT-3)	
84482		 $                                        43.54 	T3 reverse	
84484		 $                                        18.47 	Assay of troponin quant	
84485		 $                                        11.73 	Assay duodenal fluid trypsin	
84488		 $                                        11.73 	Test feces for trypsin	
84490		 $                                        15.75 	Assay of feces for trypsin	
84510		 $                                        28.74 	Assay of tyrosine	
84512		 $                                        21.27 	Assay of troponin qual	
84520		 $                                        10.90 	Assay of urea nitrogen	
84520	QW	 $                                        10.90 	Assay of urea nitrogen	
84525		 $                                          4.77 	Urea nitrogen semi-quant	
84540		 $                                        13.11 	Assay of urine/urea-n	
84545		 $                                        18.25 	Urea-N clearance test	
84550		 $                                        12.48 	Assay of blood/uric acid	
84550	QW	 $                                        12.48 	Assay of blood/uric acid	
84560		 $                                        13.11 	Assay of urine/uric acid	
84577		 $                                        34.47 	Assay of feces/urobilinogen	
84578		 $                                          3.88 	Test urine urobilinogen	
84580		 $                                        19.61 	Assay of urine urobilinogen	
84583		 $                                        13.91 	Assay of urine urobilinogen	
84585		 $                                        42.81 	Assay of urine vma	
84586		 $                                        41.23 	Assay of vip	
84588		 $                                        90.09 	Assay of vasopressin	
84590		 $                                        32.05 	Assay of vitamin a	
84591		 $                                        32.05 	Assay of nos vitamin	
84597		 $                                        37.88 	Assay of vitamin k	
84600		 $                                        44.42 	Assay of volatiles	
84620		 $                                        32.72 	Xylose tolerance test	
84630		 $                                        31.47 	Assay of zinc	
84681		 $                                        48.01 	Assay of c-peptide	
84702		 $                                        41.59 	Chorionic gonadotropin test	
84703		 $                                        19.31 	Chorionic gonadotropin assay	
84703	QW	 $                                        19.31 	Chorionic gonadotropin assay	
84704		 $                                        41.59 	Hcg free betachain test	
84830		 $                                        27.71 	Ovulation tests	
85002		 $                                        12.44 	Bleeding time test	
85004		 $                                        13.76 	Automated diff wbc count	
85007		 $                                          9.50 	Bl smear w/diff wbc count	
85008		 $                                          9.50 	Bl smear w/o diff wbc count	
85009		 $                                        10.27 	Manual diff wbc count b-coat	
85013		 $                                          6.56 	Spun microhematocrit	
85014		 $                                          6.56 	Hematocrit	
85014	QW	 $                                          6.56 	Hematocrit	
85018		 $                                          6.56 	Hemoglobin	
85018	QW	 $                                          6.56 	Hemoglobin	
85025		 $                                        19.53 	Complete cbc w/auto diff wbc	
85027		 $                                        13.76 	Complete cbc automated	
85032		 $                                        11.88 	Manual cell count each	
85041		 $                                          8.34 	Automated rbc count	
85044		 $                                        11.88 	Manual reticulocyte count	
85045		 $                                        11.04 	Automated reticulocyte count	
85046		 $                                        15.41 	Reticyte/hgb concentrate	
85048		 $                                          7.02 	Automated leukocyte count	
85049		 $                                        12.36 	Automated platelet count	
85055		 $                                        50.00 	Reticulated platelet assay	
85130		 $                                        19.53 	Chromogenic substrate assay	
85170		 $                                          9.99 	Blood clot retraction	
85175		 $                                        12.57 	Blood clot lysis time	
85210		 $                                        35.87 	Clot factor ii prothrom spec	
85220		 $                                        48.74 	Blooc clot factor v test	
85230		 $                                        49.47 	Clot factor vii proconvertin	
85240		 $                                        49.47 	Clot factor viii ahg 1 stage	
85244		 $                                        56.41 	Clot factor viii reltd antgn	
85245		 $                                        63.38 	Clot factor viii vw ristoctn	
85246		 $                                        63.38 	Clot factor viii vw antigen	
85247		 $                                        63.38 	Clot factor viii multimetric	
85250		 $                                        52.60 	Clot factor ix ptc/chrstmas	
85260		 $                                        49.47 	Clot factor x stuart-power	
85270		 $                                        49.47 	Clot factor xi pta	
85280		 $                                        53.45 	Clot factor xii hageman	
85290		 $                                        45.15 	Clot factor xiii fibrin stab	
85291		 $                                        24.58 	Clot factor xiii fibrin scrn	
85292		 $                                        52.31 	Clot factor fletcher fact	
85293		 $                                        52.31 	Clot factor wght kininogen	
85300		 $                                        32.74 	Antithrombin iii activity	
85301		 $                                        29.86 	Antithrombin iii antigen	
85302		 $                                        33.19 	Clot inhibit prot c antigen	
85303		 $                                        38.20 	Clot inhibit prot c activity	
85305		 $                                        32.05 	Clot inhibit prot s total	
85306		 $                                        42.33 	Clot inhibit prot s free	
85307		 $                                        42.33 	Assay activated protein c	
85335		 $                                        25.46 	Factor inhibitor test	
85337		 $                                        28.81 	Thrombomodulin	
85345		 $                                        11.88 	Coagulation time lee & white	
85347		 $                                        11.75 	Coagulation time activated	
85348		 $                                        10.29 	Coagulation time otr method	
85360		 $                                        12.79 	Euglobulin lysis	
85362		 $                                        19.04 	Fibrin degradation products	
85366		 $                                        23.79 	Fibrinogen test	
85370		 $                                        31.36 	Fibrinogen test	
85378		 $                                        19.71 	Fibrin degrade semiquant	
85379		 $                                        22.37 	Fibrin degradation quant	
85380		 $                                        22.37 	Fibrin degradj d-dimer	
85384		 $                                        23.47 	Fibrinogen activity	
85385		 $                                        23.47 	Fibrinogen antigen	
85390		 $                                        11.73 	Fibrinolysins screen i&r	
85397		 $                                        63.38 	Clotting funct activity	
85400		 $                                        24.44 	Fibrinolytic plasmin	
85410		 $                                        19.57 	Fibrinolytic antiplasmin	
85415		 $                                        47.50 	Fibrinolytic plasminogen	
85420		 $                                        18.05 	Fibrinolytic plasminogen	
85421		 $                                        28.14 	Fibrinolytic plasminogen	
85441		 $                                        11.61 	Heinz bodies direct	
85445		 $                                        18.84 	Heinz bodies induced	
85460		 $                                        21.38 	Hemoglobin fetal	
85461		 $                                        18.33 	Hemoglobin fetal	
85475		 $                                        24.52 	Hemolysin acid	
85520		 $                                        29.41 	Heparin assay	
85525		 $                                        32.72 	Heparin neutralization	
85530		 $                                        39.16 	Heparin-protamine tolerance	
85536		 $                                        17.88 	Iron stain peripheral blood	
85540		 $                                        23.77 	Wbc alkaline phosphatase	
85547		 $                                        23.77 	RBC mechanical fragility	
85549		 $                                        51.81 	Muramidase	
85555		 $                                        18.45 	RBC osmotic fragility	
85557		 $                                        36.91 	RBC osmotic fragility	
85576		 $                                        59.36 	Blood platelet aggregation	
85576	QW	 $                                        59.36 	Blood platelet aggregation	
85597		 $                                        42.45 	Phospholipid pltlt neutraliz	
85598		 $                                        42.45 	Hexagnal phosph pltlt neutrl	
85610		 $                                        10.86 	Prothrombin time	
85610	QW	 $                                        10.86 	Prothrombin time	
85611		 $                                        10.88 	Prothrombin test	
85612		 $                                        26.45 	Viper venom prothrombin time	
85613		 $                                        26.45 	Russell viper venom diluted	
85635		 $                                        27.18 	Reptilase test	
85651		 $                                          9.78 	Rbc sed rate nonautomated	
85652		 $                                          7.47 	Rbc sed rate automated	
85660		 $                                        15.23 	RBC sickle cell test	
85670		 $                                        15.94 	Thrombin time plasma	
85675		 $                                        18.92 	Thrombin time titer	
85705		 $                                        19.31 	Thromboplastin inhibition	
85730		 $                                        16.59 	Thromboplastin time partial	
85732		 $                                        17.88 	Thromboplastin time partial	
85810		 $                                        32.26 	Blood viscosity examination	
86000		 $                                        19.29 	Agglutinins febrile antigen	
86001		 $                                        13.22 	Allergen specific igg	
86003		 $                                        13.22 	Allergen specific IgE	
86005		 $                                        19.35 	Allergen specific IgE	
86021		 $                                        41.59 	WBC antibody identification	
86022		 $                                        50.75 	Platelet antibodies	
86023		 $                                        34.41 	Immunoglobulin assay	
86038		 $                                        33.39 	Antinuclear antibodies	
86039		 $                                        30.84 	Antinuclear antibodies (ANA)	
86060		 $                                        15.55 	Antistreptolysin o titer	
86063		 $                                          9.85 	Antistreptolysin o screen	
86140		 $                                        14.29 	C-reactive protein	
86141		 $                                        35.77 	C-reactive protein hs	
86146		 $                                        42.22 	Beta-2 glycoprotein antibody	
86147		 $                                        42.22 	Cardiolipin antibody ea ig	
86148		 $                                        44.40 	Anti-phospholipid antibody	
86152		 $                                     678.77 	Cell enumeration & id	
86155		 $                                        43.04 	Chemotaxis assay	
86156		 $                                        18.51 	Cold agglutinin screen	
86157		 $                                        22.27 	Cold agglutinin titer	
86160		 $                                        33.15 	Complement antigen	
86161		 $                                        33.15 	Complement/function activity	
86162		 $                                        56.13 	Complement total (ch50)	
86171		 $                                        27.65 	Complement fixation each	
86185		 $                                        24.71 	Counterimmunoelectrophoresis	
86200		 $                                        35.77 	Ccp antibody	
86215		 $                                        36.60 	Deoxyribonuclease antibody	
86225		 $                                        37.94 	Dna antibody native	
86226		 $                                        33.45 	Dna antibody single strand	
86235		 $                                        41.27 	Nuclear antigen antibody	
86243		 $                                        56.68 	Fc receptor	
86255		 $                                        33.29 	Fluorescent antibody screen	
86256		 $                                        33.29 	Fluorescent antibody titer	
86277		 $                                        43.48 	Growth hormone antibody	
86280		 $                                        22.61 	Hemagglutination inhibition	
86294		 $                                        54.20 	Immunoassay tumor qual	
86294	QW	 $                                        54.20 	Immunoassay tumor qual	
86300		 $                                        57.49 	Immunoassay tumor ca 15-3	
86301		 $                                        57.49 	Immunoassay tumor ca 19-9	
86304		 $                                        57.49 	Immunoassay tumor ca 125	
86305		 $                                        57.49 	Human epididymis protein 4	
86308		 $                                        14.29 	Heterophile antibody screen	
86308	QW	 $                                        14.29 	Heterophile antibody screen	
86309		 $                                        17.88 	Heterophile antibody titer	
86310		 $                                        20.36 	Heterophile antibody absrbj	
86316		 $                                        57.49 	Immunoassay tumor other	
86317		 $                                        41.41 	Immunoassay infectious agent	
86318		 $                                        35.77 	Immunoassay infectious agent	
86318	QW	 $                                        35.77 	Immunoassay infectious agent	
86320		 $                                        61.92 	Serum immunoelectrophoresis	
86325		 $                                        61.79 	Other immunoelectrophoresis	
86327		 $                                        62.69 	Immunoelectrophoresis assay	
86329		 $                                        38.79 	Immunodiffusion nes	
86331		 $                                        33.09 	Immunodiffusion ouchterlony	
86332		 $                                        47.58 	Immune complex assay	
86334		 $                                        61.73 	Immunofix e-phoresis serum	
86335		 $                                        81.08 	Immunfix e-phorsis/urine/csf	
86336		 $                                        35.79 	Inhibin A	
86337		 $                                        59.13 	Insulin antibodies	
86340		 $                                        41.64 	Intrinsic factor antibody	
86341		 $                                        37.09 	Islet cell antibody	
86343		 $                                        34.43 	Leukocyte histamine release	
86344		 $                                        22.07 	Leukocyte phagocytosis	
86352		 $                                     375.33 	Cell function assay w/stim	
86353		 $                                     135.44 	Lymphocyte transformation	
86355		 $                                        49.07 	B cells total count	
86356		 $                                        50.00 	Mononuclear cell antigen	
86357		 $                                        49.07 	Nk cells total count	
86359		 $                                        49.07 	T cells total count	
86360		 $                                        98.09 	T cell absolute count/ratio	
86361		 $                                        50.00 	T cell absolute count	
86367		 $                                        49.07 	Stem cells total count	
86376		 $                                        40.19 	Microsomal antibody each	
86378		 $                                        54.40 	Migration inhibitory factor	
86382		 $                                        46.71 	Neutralization test viral	
86384		 $                                        31.47 	Nitroblue tetrazolium dye	
86386		 $                                        44.11 	Nuclear matrix protein 22	
86386	QW	 $                                        44.11 	Nuclear matrix protein 22	
86403		 $                                        19.31 	Particle agglut antbdy scrn	
86406		 $                                        29.37 	Particle agglut antbdy titr	
86430		 $                                        15.67 	Rheumatoid factor test qual	
86431		 $                                        15.67 	Rheumatoid factor quant	
86480		 $                                     171.23 	Tb test cell immun measure	
86481		 $                                     206.98 	Tb ag response t-cell susp	
86590		 $                                        29.41 	Streptokinase antibody	
86592		 $                                        11.79 	Syphilis test non-trep qual	
86593		 $                                        12.16 	Syphilis test non-trep quant	
86602		 $                                        28.12 	Antinomyces antibody	
86603		 $                                        30.98 	Adenovirus antibody	
86606		 $                                        38.85 	Aspergillus antibody	
86609		 $                                        35.59 	Bacterium antibody	
86611		 $                                        28.12 	Bartonella antibody	
86612		 $                                        30.98 	Blastomyces antibody	
86615		 $                                        36.44 	Bordetella antibody	
86617		 $                                        42.79 	Lyme disease antibody	
86618		 $                                        47.06 	Lyme disease antibody	
86618	QW	 $                                        47.06 	Lyme disease antibody	
86619		 $                                        36.97 	Borrelia antibody	
86622		 $                                        22.59 	Brucella antibody	
86625		 $                                        36.26 	Campylobacter antibody	
86628		 $                                        33.17 	Candida antibody	
86631		 $                                        32.66 	Chlamydia antibody	
86632		 $                                        35.06 	Chlamydia igm antibody	
86635		 $                                        30.98 	Coccidioides antibody	
86638		 $                                        30.98 	Q fever antibody	
86641		 $                                        19.31 	Cryptococcus antibody	
86644		 $                                        39.75 	CMV antibody	
86645		 $                                        39.44 	Cmv antibody igm	
86648		 $                                        42.00 	Diphtheria antibody	
86651		 $                                        36.44 	Encephalitis californ antbdy	
86652		 $                                        36.44 	Encephaltis east eqne anbdy	
86653		 $                                        36.44 	Encephaltis st louis antbody	
86654		 $                                        36.44 	Encephaltis west eqne antbdy	
86658		 $                                        30.98 	Enterovirus antibody	
86663		 $                                        36.26 	Epstein-barr antibody	
86664		 $                                        39.44 	Epstein-barr nuclear antigen	
86665		 $                                        39.44 	Epstein-barr capsid vca	
86666		 $                                        28.12 	Ehrlichia antibody	
86668		 $                                        21.54 	Francisella tularensis	
86671		 $                                        30.98 	Fungus nes antibody	
86674		 $                                        39.44 	Giardia lamblia antibody	
86677		 $                                        40.07 	Helicobacter pylori antibody	
86682		 $                                        28.58 	Helminth antibody	
86684		 $                                        19.31 	Hemophilus influenza antibdy	
86687		 $                                        23.18 	Htlv-i antibody	
86688		 $                                        27.57 	Htlv-ii antibody	
86689		 $                                        53.47 	Htlv/hiv confirmj antibody	
86692		 $                                        47.40 	Hepatitis delta agent antbdy	
86694		 $                                        39.75 	Herpes simplex nes antbdy	
86695		 $                                        36.44 	Herpes simplex type 1 test	
86696		 $                                        53.47 	Herpes simplex type 2 test	
86698		 $                                        30.98 	Histoplasma antibody	
86701		 $                                        24.54 	Hiv-1antibody	
86701	QW	 $                                        24.54 	Hiv-1antibody	
86702		 $                                        27.57 	Hiv-2 antibody	
86703		 $                                        27.57 	Hiv-1/hiv-2 1 result antbdy	
86704		 $                                        33.29 	Hep b core antibody total	
86705		 $                                        32.54 	Hep b core antibody igm	
86706		 $                                        29.68 	Hep b surface antibody	
86707		 $                                        31.97 	Hepatitis be antibody	
86708		 $                                        34.23 	Hepatitis a total antibody	
86709		 $                                        31.10 	Hepatitis a igm antibody	
86710		 $                                        37.43 	Influenza virus antibody	
86711		 $                                        39.75 	John cunningham antibody	
86713		 $                                        39.44 	Legionella antibody	
86717		 $                                        33.84 	Leishmania antibody	
86720		 $                                        36.44 	Leptospira antibody	
86723		 $                                        36.44 	Listeria monocytogenes	
86727		 $                                        30.98 	Lymph choriomeningitis ab	
86729		 $                                        33.01 	Lympho venereum antibody	
86732		 $                                        36.44 	Mucormycosis antibody	
86735		 $                                        36.05 	Mumps antibody	
86738		 $                                        36.58 	Mycoplasma antibody	
86741		 $                                        36.44 	Neisseria meningitidis	
86744		 $                                        36.44 	Nocardia antibody	
86747		 $                                        41.53 	Parvovirus antibody	
86750		 $                                        36.44 	Malaria antibody	
86753		 $                                        28.58 	Protozoa antibody nos	
86756		 $                                        35.61 	Respiratory virus antibody	
86757		 $                                        53.47 	Rickettsia antibody	
86759		 $                                        36.44 	Rotavirus antibody	
86762		 $                                        39.75 	Rubella antibody	
86765		 $                                        35.59 	Rubeola antibody	
86768		 $                                        36.44 	Salmonella antibody	
86771		 $                                        36.44 	Shigella antibody	
86774		 $                                        40.88 	Tetanus antibody	
86777		 $                                        39.75 	Toxoplasma antibody	
86778		 $                                        39.44 	Toxoplasma antibody igm	
86780		 $                                        36.58 	Treponema pallidum	
86784		 $                                        17.56 	Trichinella antibody	
86787		 $                                        35.59 	Varicella-zoster antibody	
86788		 $                                        39.44 	West nile virus ab igm	
86789		 $                                        39.75 	West nile virus antibody	
86790		 $                                        35.59 	Virus antibody nos	
86793		 $                                        36.44 	Yersinia antibody	
86800		 $                                        43.95 	Thyroglobulin antibody	
86803		 $                                        39.42 	Hepatitis c ab test	
86803	QW	 $                                        39.42 	Hepatitis c ab test	
86804		 $                                        42.79 	Hep c ab test confirm	
86805		 $                                     144.45 	Lymphocytotoxicity assay	
86806		 $                                     131.46 	Lymphocytotoxicity assay	
86807		 $                                     109.34 	Cytotoxic antibody screening	
86808		 $                                        81.99 	Cytotoxic antibody screening	
86812		 $                                        71.29 	Hla typing a b or c	
86813		 $                                        88.22 	Hla typing a b or c	
86816		 $                                        76.96 	Hla typing dr/dq	
86817		 $                                     177.87 	Hla typing dr/dq	
86821		 $                                     155.96 	Lymphocyte culture mixed	
86822		 $                                     100.99 	Lymphocyte culture primed	
86825		 $                                     149.98 	Hla x-math non-cytotoxic	
86826		 $                                        50.00 	Hla x-match noncytotoxc addl	
86828		 $                                     109.34 	Hla class i&ii antibody qual	
86829		 $                                        81.99 	Hla class i/ii antibody qual	
86830		 $                                     223.04 	Hla class i phenotype qual	
86831		 $                                     191.19 	Hla class ii phenotype qual	
86832		 $                                     350.50 	Hla class i high defin qual	
86833		 $                                     318.65 	Hla class ii high defin qual	
86834		 $                                     987.78 	Hla class i semiquant panel	
86835		 $                                     892.16 	Hla class ii semiquant panel	
86880		 $                                        14.88 	Coombs test direct	
86885		 $                                        15.81 	Coombs test indirect qual	
86886		 $                                        14.29 	Coombs test indirect titer	
86900		 $                                          8.24 	Blood typing abo	
86901		 $                                          8.24 	Blood typing rh (d)	
86902		 $                                        10.56 	Blood type antigen donor ea	
86904		 $                                        26.27 	Blood typing patient serum	
86905		 $                                        10.56 	Blood typing rbc antigens	
86906		 $                                        17.72 	Blood typing rh phenotype	
86940		 $                                        22.65 	Hemolysins/agglutinins auto	
86941		 $                                        33.45 	Hemolysins/agglutinins	
87003		 $                                        46.51 	Small animal inoculation	
87015		 $                                        18.45 	Specimen infect agnt concntj	
87040		 $                                        28.52 	Blood culture for bacteria	
87045		 $                                        26.09 	Feces culture aerobic bact	
87046		 $                                        26.09 	Stool cultr aerobic bact ea	
87070		 $                                        23.79 	Culture othr specimn aerobic	
87071		 $                                        26.09 	Culture aerobic quant other	
87073		 $                                        26.09 	Culture bacteria anaerobic	
87075		 $                                        26.15 	Cultr bacteria except blood	
87076		 $                                        19.57 	Culture anaerobe ident each	
87077		 $                                        19.57 	Culture aerobic identify	
87077	QW	 $                                        19.57 	Culture aerobic identify	
87081		 $                                        18.31 	Culture screen only	
87084		 $                                        23.79 	Culture of specimen by kit	
87086		 $                                        22.31 	Urine culture/colony count	
87088		 $                                        22.37 	Urine bacteria culture	
87101		 $                                        21.29 	Skin fungi culture	
87102		 $                                        23.20 	Fungus isolation culture	
87103		 $                                        24.91 	Blood fungus culture	
87106		 $                                        28.52 	Fungi identification yeast	
87107		 $                                        28.52 	Fungi identification mold	
87109		 $                                        42.51 	Mycoplasma	
87110		 $                                        54.12 	Chlamydia culture	
87116		 $                                        29.84 	Mycobacteria culture	
87118		 $                                        30.25 	Mycobacteric identification	
87140		 $                                        15.41 	Culture type immunofluoresc	
87143		 $                                        34.61 	Culture typing glc/hplc	
87147		 $                                        14.29 	Culture type immunologic	
87149		 $                                        55.40 	Dna/rna direct probe	
87150		 $                                        96.95 	Dna/rna amplified probe	
87152		 $                                        14.45 	Culture type pulse field gel	
87153		 $                                     318.67 	Dna/rna sequencing	
87158		 $                                        14.45 	Culture typing added method	
87164		 $                                        29.68 	Dark field examination	
87166		 $                                        31.20 	Dark field examination	
87168		 $                                        11.79 	Macroscopic exam arthropod	
87169		 $                                        11.79 	Macroscopic exam parasite	
87172		 $                                        11.79 	Pinworm exam	
87176		 $                                        16.26 	Tissue homogenization cultr	
87177		 $                                        24.58 	Ova and parasites smears	
87181		 $                                        13.11 	Microbe susceptible diffuse	
87184		 $                                        19.06 	Microbe susceptible disk	
87185		 $                                        13.11 	Microbe susceptible enzyme	
87186		 $                                        23.89 	Microbe susceptible mic	
87187		 $                                        28.62 	Microbe susceptible mlc	
87188		 $                                        18.35 	Microbe suscept macrobroth	
87190		 $                                        11.73 	Microbe suscept mycobacteri	
87197		 $                                        41.51 	Bactericidal level serum	
87205		 $                                        11.79 	Smear gram stain	
87206		 $                                        14.88 	Smear fluorescent/acid stai	
87207		 $                                        15.75 	Smear special stain	
87209		 $                                        47.28 	Smear complex stain	
87210		 $                                        11.79 	Smear wet mount saline/ink	
87210	QW	 $                                        11.79 	Smear wet mount saline/ink	
87220		 $                                        11.79 	Tissue exam for fungi	
87230		 $                                        54.55 	Assay toxin or antitoxin	
87250		 $                                        54.04 	Virus inoculate eggs/animal	
87252		 $                                        72.02 	Virus inoculation tissue	
87253		 $                                        55.80 	Virus inoculate tissue addl	
87254		 $                                        54.04 	Virus inoculation shell via	
87255		 $                                        93.54 	Genet virus isolate hsv	
87260		 $                                        33.13 	Adenovirus ag if	
87265		 $                                        33.13 	Pertussis ag if	
87267		 $                                        33.13 	Enterovirus antibody dfa	
87269		 $                                        33.13 	Giardia ag if	
87270		 $                                        33.13 	Chlamydia trachomatis ag if	
87271		 $                                        33.13 	Cytomegalovirus dfa	
87272		 $                                        33.13 	Cryptosporidium ag if	
87273		 $                                        33.13 	Herpes simplex 2 ag if	
87274		 $                                        33.13 	Herpes simplex 1 ag if	
87275		 $                                        33.13 	Influenza b ag if	
87276		 $                                        33.13 	Influenza a ag if	
87277		 $                                        33.13 	Legionella micdadei ag if	
87278		 $                                        33.13 	Legion pneumophilia ag if	
87279		 $                                        33.13 	Parainfluenza ag if	
87280		 $                                        33.13 	Respiratory syncytial ag if	
87281		 $                                        33.13 	Pneumocystis carinii ag if	
87283		 $                                        33.13 	Rubeola ag if	
87285		 $                                        33.13 	Treponema pallidum ag if	
87290		 $                                        33.13 	Varicella zoster ag if	
87299		 $                                        33.13 	Antibody detection nos if	
87300		 $                                        33.13 	Ag detection polyval if	
87301		 $                                        33.13 	Adenovirus ag eia	
87305		 $                                        33.13 	Aspergillus ag eia	
87320		 $                                        33.13 	Chylmd trach ag eia	
87324		 $                                        33.13 	Clostridium ag eia	
87327		 $                                        33.13 	Cryptococcus neoform ag eia	
87328		 $                                        33.13 	Cryptosporidium ag eia	
87329		 $                                        33.13 	Giardia ag eia	
87332		 $                                        33.13 	Cytomegalovirus ag eia	
87335		 $                                        33.13 	E coli 0157 ag eia	
87336		 $                                        33.13 	Entamoeb hist dispr ag eia	
87337		 $                                        33.13 	Entamoeb hist group ag eia	
87338		 $                                        33.15 	Hpylori stool eia	
87339		 $                                        33.13 	H pylori ag eia	
87340		 $                                        28.54 	Hepatitis b surface ag eia	
87341		 $                                        28.54 	Hepatitis b surface ag eia	
87350		 $                                        31.85 	Hepatitis be ag eia	
87380		 $                                        45.33 	Hepatitis delta ag eia	
87385		 $                                        33.13 	Histoplasma capsul ag eia	
87389		 $                                        66.52 	Hiv-1 ag w/hiv-1 & hiv-2 ab	
87390		 $                                        48.74 	Hiv-1 ag eia	
87391		 $                                        48.74 	Hiv-2 ag eia	
87400		 $                                        33.13 	Influenza a/b ag eia	
87420		 $                                        33.13 	Resp syncytial ag eia	
87425		 $                                        33.13 	Rotavirus ag eia	
87427		 $                                        33.13 	Shiga-like toxin ag eia	
87430		 $                                        33.13 	Strep a ag eia	
87449		 $                                        33.13 	Ag detect nos eia mult	
87449	QW	 $                                        33.13 	Ag detect nos eia mult	
87450		 $                                        26.49 	Ag detect nos eia single	
87451		 $                                        26.49 	Ag detect polyval eia mult	
87470		 $                                        55.40 	Bartonella dna dir probe	
87471		 $                                        96.95 	Bartonella dna amp probe	
87472		 $                                     118.33 	Bartonella dna quant	
87475		 $                                        55.40 	Lyme dis dna dir probe	
87476		 $                                        96.95 	Lyme dis dna amp probe	
87477		 $                                     118.33 	Lyme dis dna quant	
87480		 $                                        55.40 	Candida dna dir probe	
87481		 $                                        96.95 	Candida dna amp probe	
87482		 $                                     115.34 	Candida dna quant	
87485		 $                                        55.40 	Chylmd pneum dna dir probe	
87486		 $                                        96.95 	Chylmd pneum dna amp probe	
87487		 $                                     118.33 	Chylmd pneum dna quant	
87490		 $                                        55.40 	Chylmd trach dna dir probe	
87491		 $                                        96.95 	Chylmd trach dna amp probe	
87492		 $                                        96.57 	Chylmd trach dna quant	
87493		 $                                        96.95 	C diff amplified probe	
87495		 $                                        55.40 	Cytomeg dna dir probe	
87496		 $                                        96.95 	Cytomeg dna amp probe	
87497		 $                                     118.33 	Cytomeg dna quant	
87498		 $                                        96.95 	Enterovirus probe&revrs trns	
87500		 $                                        96.95 	Vanomycin dna amp probe	
87501		 $                                     141.75 	Influenza dna amp prob 1+	
87502		 $                                     235.07 	Influenza dna amp probe	
87503		 $                                        57.37 	Influenza dna amp prob addl	
87505		 $                                     354.40 	Nfct agent detection gi	
87506		 $                                     589.61 	Iadna-dna/rna probe tq 6-11	
87507		 $                                  1,151.38 	Iadna-dna/rna probe tq 12-25	
87510		 $                                        55.40 	Gardner vag dna dir probe	
87511		 $                                        96.95 	Gardner vag dna amp probe	
87512		 $                                     115.34 	Gardner vag dna quant	
87515		 $                                        55.40 	Hepatitis b dna dir probe	
87516		 $                                        96.95 	Hepatitis b dna amp probe	
87517		 $                                     118.33 	Hepatitis b dna quant	
87520		 $                                        55.40 	Hepatitis c rna dir probe	
87521		 $                                        96.95 	Hepatitis c probe&rvrs trnsc	
87522		 $                                     118.33 	Hepatitis c revrs trnscrpj	
87525		 $                                        55.40 	Hepatitis g dna dir probe	
87526		 $                                        96.95 	Hepatitis g dna amp probe	
87527		 $                                     115.34 	Hepatitis g dna quant	
87528		 $                                        55.40 	Hsv dna dir probe	
87529		 $                                        96.95 	Hsv dna amp probe	
87530		 $                                     118.33 	Hsv dna quant	
87531		 $                                        55.40 	Hhv-6 dna dir probe	
87532		 $                                        96.95 	Hhv-6 dna amp probe	
87533		 $                                     115.34 	Hhv-6 dna quant	
87534		 $                                        55.40 	Hiv-1 dna dir probe	
87535		 $                                        96.95 	Hiv-1 probe&reverse trnscrpj	
87536		 $                                     235.07 	Hiv-1 quant&revrse trnscrpj	
87537		 $                                        55.40 	Hiv-2 dna dir probe	
87538		 $                                        96.95 	Hiv-2 probe&revrse trnscripj	
87539		 $                                     118.33 	Hiv-2 quant&revrse trnscripj	
87540		 $                                        55.40 	Legion pneumo dna dir prob	
87541		 $                                        96.95 	Legion pneumo dna amp prob	
87542		 $                                     115.34 	Legion pneumo dna quant	
87550		 $                                        55.40 	Mycobacteria dna dir probe	
87551		 $                                        96.95 	Mycobacteria dna amp probe	
87552		 $                                     118.33 	Mycobacteria dna quant	
87555		 $                                        55.40 	M.tuberculo dna dir probe	
87556		 $                                        96.95 	M.tuberculo dna amp probe	
87557		 $                                     118.33 	M.tuberculo dna quant	
87560		 $                                        55.40 	M.avium-intra dna dir prob	
87561		 $                                        96.95 	M.avium-intra dna amp prob	
87562		 $                                     118.33 	M.avium-intra dna quant	
87580		 $                                        55.40 	M.pneumon dna dir probe	
87581		 $                                        96.95 	M.pneumon dna amp probe	
87582		 $                                     115.34 	M.pneumon dna quant	
87590		 $                                        55.40 	N.gonorrhoeae dna dir prob	
87591		 $                                        96.95 	N.gonorrhoeae dna amp prob	
87592		 $                                     118.33 	N.gonorrhoeae dna quant	
87623		 $                                        96.95 	Hpv low-risk types	
87624		 $                                        96.95 	Hpv high-risk types	
87625		 $                                        96.95 	Hpv types 16 & 18 only	
87631		 $                                     354.40 	Resp virus 3-11 targets	
87632		 $                                     589.61 	Resp virus 6-11 targets	
87633		 $                                  1,151.38 	Resp virus 12-25 targets	
87640		 $                                        96.95 	Staph a dna amp probe	
87641		 $                                        96.95 	Mr-staph dna amp probe	
87650		 $                                        55.40 	Strep a dna dir probe	
87651		 $                                        96.95 	Strep a dna amp probe	
87652		 $                                     115.34 	Strep a dna quant	
87653		 $                                        96.95 	Strep b dna amp probe	
87660		 $                                        55.40 	Trichomonas vagin dir probe	
87661		 $                                        96.95 	Trichomonas vaginalis amplif	
87797		 $                                        55.40 	Detect agent nos dna dir	
87798		 $                                        96.95 	Detect agent nos dna amp	
87799		 $                                     118.33 	Detect agent nos dna quant	
87800		 $                                     110.82 	Detect agnt mult dna direc	
87801		 $                                     193.91 	Detect agnt mult dna ampli	
87802		 $                                        33.13 	Strep b assay w/optic	
87803		 $                                        33.13 	Clostridium toxin a w/optic	
87804		 $                                        33.13 	Influenza assay w/optic	
87804	QW	 $                                        33.13 	Influenza assay w/optic	
87806		 $                                        66.52 	Hiv antigen w/hiv antibodies	
87807		 $                                        33.13 	Rsv assay w/optic	
87807	QW	 $                                        33.13 	Rsv assay w/optic	
87808		 $                                        33.13 	Trichomonas assay w/optic	
87808	QW	 $                                        33.13 	Trichomonas assay w/optic	
87809		 $                                        33.13 	Adenovirus assay w/optic	
87809	QW	 $                                        33.13 	Adenovirus assay w/optic	
87810		 $                                        33.13 	Chylmd trach assay w/optic	
87850		 $                                        33.13 	N. gonorrhoeae assay w/optic	
87880		 $                                        33.13 	Strep a assay w/optic	
87880	QW	 $                                        33.13 	Strep a assay w/optic	
87899		 $                                        33.13 	Agent nos assay w/optic	
87899	QW	 $                                        33.13 	Agent nos assay w/optic	
87900		 $                                     360.08 	Phenotype infect agent drug	
87901		 $                                     711.21 	Genotype dna hiv reverse t	
87902		 $                                     711.21 	Genotype dna/rna hep c	
87903		 $                                  1,349.91 	Phenotype dna hiv w/culture	
87904		 $                                        72.02 	Phenotype dna hiv w/clt add	
87905		 $                                        14.47 	Sialidase enzyme assay	
87905	QW	 $                                        14.47 	Sialidase enzyme assay	
87906		 $                                     355.62 	Genotype dna/rna hiv	
87910		 $                                     711.21 	Genotype cytomegalovirus	
87912		 $                                     711.21 	Genotype dna hepatitis b	
88130		 $                                        41.57 	Sex chromatin identification	
88140		 $                                          8.02 	Sex chromatin identification	
88142		 $                                        55.97 	Cytopath c/v thin layer	
88143		 $                                        55.97 	Cytopath c/v thin layer redo	
88147		 $                                        31.44 	Cytopath c/v automated	
88148		 $                                        41.98 	Cytopath c/v auto rescreen	
88150		 $                                        29.19 	Cytopath c/v manual	
88152		 $                                        29.19 	Cytopath c/v auto redo	
88153		 $                                        29.19 	Cytopath c/v redo	
88154		 $                                        29.19 	Cytopath c/v select	
88155		 $                                        16.54 	Cytopath c/v index add-on	
88164		 $                                        29.19 	Cytopath tbs c/v manual	
88165		 $                                        29.19 	Cytopath tbs c/v redo	
88166		 $                                        29.19 	Cytopath tbs c/v auto redo	
88167		 $                                        29.19 	Cytopath tbs c/v select	
88174		 $                                        59.03 	Cytopath c/v auto in fluid	
88175		 $                                        73.18 	Cytopath c/v auto fluid redo	
88230		 $                                     101.87 	Tissue culture lymphocyte	
88233		 $                                     203.69 	Tissue culture skin/biopsy	
88235		 $                                     203.69 	Tissue culture placenta	
88237		 $                                     348.94 	Tissue culture bone marrow	
88239		 $                                     407.52 	Tissue culture tumor	
88240		 $                                        27.89 	Cell cryopreserve/storage	
88241		 $                                        27.89 	Frozen cell preparation	
88245		 $                                     411.24 	Chromosome analysis 20-25	
88248		 $                                     478.41 	Chromosome analysis 50-100	
88249		 $                                     478.41 	Chromosome analysis 100	
88261		 $                                     488.24 	Chromosome analysis 5	
88262		 $                                     344.33 	Chromosome analysis 15-20	
88263		 $                                     415.18 	Chromosome analysis 45	
88264		 $                                     344.33 	Chromosome analysis 20-25	
88267		 $                                     496.62 	Chromosome analys placenta	
88269		 $                                     459.47 	Chromosome analys amniotic	
88271		 $                                        59.15 	Cytogenetics dna probe	
88272		 $                                        73.97 	Cytogenetics 3-5	
88273		 $                                        88.77 	Cytogenetics 10-30	
88274		 $                                        96.16 	Cytogenetics 25-99	
88275		 $                                     110.94 	Cytogenetics 100-300	
88280		 $                                        69.32 	Chromosome karyotype study	
88283		 $                                     189.50 	Chromosome banding study	
88285		 $                                        52.50 	Chromosome count additional	
88289		 $                                        95.13 	Chromosome study additional	
88371		 $                                        61.35 	Protein western blot tissue	
88372		 $                                        54.57 	Protein analysis w/probe	
88720		 $                                        13.86 	Bilirubin total transcut	
88738		 $                                        13.86 	Hgb quant transcutaneous	
88740		 $                                        13.86 	Transcutaneous carboxyhb	
88741		 $                                        13.86 	Transcutaneous methb	
89050		 $                                        11.73 	Body fluid cell count	
89051		 $                                        15.20 	Body fluid cell count	
89055		 $                                        11.79 	Leukocyte assessment fecal	
89060		 $                                        19.77 	Exam synovial fluid crystals	
89125		 $                                        11.94 	Specimen fat stain	
89160		 $                                          9.85 	Exam feces for meat fibers	
89190		 $                                          9.85 	Nasal smear for eosinophils	
89300		 $                                        24.64 	Semen analysis w/huhner	
89300	QW	 $                                        24.64 	Semen analysis w/huhner	
89310		 $                                        17.56 	Semen analysis w/count	
89320		 $                                        33.29 	Semen anal vol/count/mot	
89321		 $                                        33.29 	Semen anal sperm detection	
89321	QW	 $                                        33.29 	Semen anal sperm detection	
89322		 $                                        42.81 	Semen anal strict criteria	
89325		 $                                        21.54 	Sperm antibody test	
89329		 $                                        57.92 	Sperm evaluation test	
89330		 $                                        27.32 	Evaluation cervical mucus	
89331		 $                                        54.12 	Retrograde ejaculation anal	
ATP02		 $                                        14.39 	Auto.Test Panel Pricing Code, 1-2 Tests	
ATP03		 $                                        18.35 	Auto.Test Panel Pricing Code, 3 Tests	
ATP04		 $                                        19.39 	Auto.Test Panel Pricing Code, 4 Tests	
ATP05		 $                                        21.62 	Auto.Test Panel Pricing Code, 5 Tests	
ATP06		 $                                        21.66 	Auto.Test Panel Pricing Code, 6 Tests	
ATP07		 $                                        22.55 	Auto.Test Panel Pricing Code, 7 Tests	
ATP08		 $                                        23.37 	Auto.Test Panel Pricing Code, 8 Tests	
ATP09		 $                                        23.99 	Auto.Test Panel Pricing Code, 9 Tests	
ATP10		 $                                        23.99 	Auto.Test Panel Pricing Code, 10 Tests	
ATP11		 $                                        24.42 	Auto.Test Panel Pricing Code, 11 Tests	
ATP12		 $                                        24.93 	Auto.Test Panel Pricing Code, 12 Tests	
ATP16		 $                                        29.17 	Auto Test Panel Pricing Code  13-16 Test	
ATP18		 $                                        29.39 	Auto Test Panel Pricing Code, 17-18 Test	
ATP19		 $                                        30.59 	Auto Test Panel Pricing Code, 19 Tests	
ATP20		 $                                        31.53 	Auto Test Panel Pricing Code, 20 Tests	
ATP21		 $                                        32.56 	Auto Test Panel Pricing Code, 21 Tests	
ATP22		 $                                        33.52 	Auto.Test Panel Pricing Code, 22+ Tests	
ATP23		 $                                        33.52 	Auto.Test Panel Pricing Code, 23+ Tests	
G0027		 $                                        17.97 	Semen analysis	
G0103		 $                                        50.81 	PSA screening	
G0123		 $                                        55.97 	Screen cerv/vag thin layer	
G0143		 $                                        55.97 	Scr c/v cyto,thinlayer,rescr	
G0144		 $                                        59.03 	Scr c/v cyto,thinlayer,rescr	
G0145		 $                                        73.18 	Scr c/v cyto,thinlayer,rescr	
G0147		 $                                        31.44 	Scr c/v cyto, automated sys	
G0148		 $                                        41.98 	Scr c/v cyto, autosys, rescr	
G0306		 $                                        19.53 	CBC/diffwbc w/o platelet	
G0307		 $                                        13.76 	CBC without platelet	
G0328		 $                                        43.95 	Fecal blood scrn immunoassay	
G0328	QW	 $                                        43.95 	Fecal blood scrn immunoassay	
G0431		 $                                     200.89 	Drug screen multiple class	
G0432		 $                                        27.57 	EIA HIV-1/HIV-2 screen	
G0433		 $                                        27.57 	ELISA HIV-1/HIV-2 screen	
G0433	QW	 $                                        27.57 	ELISA HIV-1/HIV-2 screen	
G0434		 $                                        40.17 	Drug screen multi drug class	
G0434	QW	 $                                        40.17 	Drug screen multi drug class	
G0435		 $                                        33.13 	Oral HIV-1/HIV-2 screen	
G0464		 $                                  1,000.22 	Colorec ca scr, sto bas dna	
G0471		 $                                        10.15 	Ven blood coll SNF/HHA	
G6030		 $                                        49.45 	Assay of amitriptyline	
G6031		 $                                        51.10 	Assay of benzodiazepines	
G6032		 $                                        47.54 	Assay of desipramine	
G6034		 $                                        42.81 	Assay of doxepin	
G6035		 $                                        44.98 	Assay of gold	
G6036		 $                                        47.54 	Assay of imipramine	
G6037		 $                                        37.43 	Assay of nortiptyline	
G6038		 $                                        19.61 	Assay of salicylate	
G6039		 $                                        52.88 	Assay of acetaminophen	
G6040		 $                                        29.84 	Assay of ethanol	
G6041		 $                                        82.93 	Assay of urine alkaloids	
G6042		 $                                        42.93 	Assay of amphetamines	
G6043		 $                                        31.63 	Assay of barbiturates	
G6044		 $                                        41.86 	Assay of cocaine	
G6045		 $                                        57.04 	Assay of dihydrocodeinone	
G6046		 $                                        71.01 	Assay of dihydromorphinone	
G6047		 $                                        52.88 	Assay of dihydrotestosterone	
G6048		 $                                        38.27 	Assay of dimethadione	
G6049		 $                                        59.36 	Asssay of epiandrosterone	
G6050		 $                                        47.75 	Assay of ethchlorvynol	
G6051		 $                                        54.69 	Assay of flurazepam	
G6052		 $                                        48.68 	Assay of meprobamate	
G6053		 $                                        45.11 	Assay of methadone	
G6054		 $                                        40.92 	Assay of methsuximide	
G6055		 $                                        65.43 	Assay of nicotine	
G6056		 $                                        53.75 	Assay of opiates	
G6057		 $                                        43.02 	Assay of phenothiazine	
G6058		 $                                        36.60 	Drug confirmation	
G9143		 $                                     333.47 	Warfarin respon genetic test	
P2038		 $                                        13.91 	Blood mucoprotein	
P3000		 $                                        29.19 	Screen pap by tech w md supv	
P9612		 $                                          6.09 	Catheterize for urine spec	
P9615		 $                                          6.09 	Urine specimen collect mult	
Q0111		 $                                        11.79 	Wet mounts/ w preparations	
Q0112		 $                                        11.79 	Potassium hydroxide preps	
Q0113		 $                                        14.94 	Pinworm examinations	
Q0114		 $                                        19.77 	Fern test	
Q0115		 $                                        27.32 	Post-coital mucous exam