22 FAMILY PLANNING 1 A4261 CERVICAL CAP FOR CONTRACEPTIVE USE F 00019.62 09012018 99999999 1 A4266 DIAPHRAGM FOR CONTRACEPTIVE USE F 00019.62 07012013 99999999 1 A4267 CONTRACEPTIVE SUPPLY,CONDOM,MALE EACH F 00000.16 07012013 99999999 1 A4268 CONTRACEPTIVE SUPPLY, CONDOM,FEMALE,EACH F 00000.30 07012013 99999999 1 A4269 CONTRACEPTIVE SUPPLY, SPERMACIDE, EACH M 00000.00 07012012 99999999 1 A4932 RECTAL THERMOMETER, REUSABLE, ANY TYPE, F 00003.10 07012013 99999999 1 E1399 DURABLE MEDICAL EQUIPMENT, NOT OTHERWISE M 00000.00 04012021 99999999 1 G0011 HIV PREP COUNSEL, MD 15-30M X 00020.02 01012025 99999999 1 G0011 HIV PREP COUNSEL, MD 15-30M F 00023.46 01012025 99999999 1 G0012 INJECTION OF HIV PREP DRUG F 00012.66 01012024 99999999 1 G0012 INJECTION OF HIV PREP DRUG X 00012.66 01012024 99999999 1 G0013 HIV PREP COUNSEL, CLIN STAFF X 00007.81 01012025 99999999 1 G0013 HIV PREP COUNSEL, CLIN STAFF F 00020.43 01012025 99999999 1 G0310 IMMUNIZATION COUNSELING F 00014.61 04012021 99999999 1 G0311 IMMUNIZATION COUNSELING F 00029.22 04012021 99999999 1 G0312 IMMUNIZATION COUNSELING F 00014.61 04012021 99999999 1 G0313 IMMUNIZATION COUNSELING F 00029.22 04012021 99999999 1 G0314 IMMUNIZATION COUNSELING F 00029.22 04012021 99999999 1 G0315 IMMUNIZATION COUNSELING F 00014.61 04012021 99999999 1 G0396 ALCOHOL &/OR SUB MISUSE ASSES 15-30 MIN F 00035.67 02012022 99999999 1 G0445 HIGH INTENSITY BEHAV COUNSELING,30 MIN F 00023.86 04012021 99999999 1 G0445 HIGH INTENSITY BEHAV COUNSELING,30 MIN X 00019.79 04012021 99999999 1 G0450 SCREEN FOR SEXUALLY TRANSMITTED INFECT M 00000.00 04012021 99999999 1 G0513 Prolonged preventive service(s) (beyond X 00055.21 04012021 99999999 1 G0513 Prolonged preventive service(s) (beyond F 00058.65 04012021 99999999 1 G0514 Prolonged preventive service(s) (beyond F 00058.65 04012021 99999999 1 G0514 Prolonged preventive service(s) (beyond X 00055.21 04012021 99999999 1 G2211 VISIT COMPLEXITY INHERENT TO EVALUATION F 00014.67 11012024 99999999 1 G2212 Prolong outpt/office vis F 00030.24 01012021 99999999 1 G2212 Prolong outpt/office vis X 00029.33 01012021 99999999 1 J1050 INJECTION, MEDROXYPROGESTERONE ACETATE, F 00000.55 07012021 99999999 1 J1568 INJ, OCTAGAM, IV, NONLYPHIL, 500MG F 00098.37 03012024 99999999 1 J3490 UNCLASSIFIED DRUGS M 00000.00 04012021 99999999 1 J3590 UNCLASSIFIED BIOLOGICALS M 00000.00 04012021 99999999 1 J7294 Segesterone acetate and ethinyl estradio F 02334.79 03012024 99999999 1 J7295 Ethinyl estradiol and etonogestrel 0.015 F 00140.00 03012024 99999999 1 J7296 Levonorgestrel-releasing intrauterine co F 01115.80 03012024 99999999 1 J7297 LEVONORGESTREL F 00855.92 02012023 99999999 1 J7298 Levonorgestrel-releasing intrauterine co F 01115.80 03012024 99999999 1 J7300 INTRAUTERINE CONTRACEPTIVE DEVICE F 01098.89 07012024 99999999 1 J7301 Levonorgestrel-releasing intrauterine co F 00929.09 03012024 99999999 1 J7304 CONTRACEPT,SUPPLY,HORMONE PATCH F 00035.23 09012018 99999999 1 J7306 LEVONORGESTREL IMPLANT SYS M 00000.00 09012018 99999999 1 J7307 ETONOGESTREL IMPLANT SYS,IMPLANT & SUP F 01171.08 02012024 99999999 1 J8498 ANTIEMETIC RECTAL/SUPP NOS M 00000.00 04012021 99999999 1 J8499 PRESCRIPTION DRUG, ORAL, NOS M 00000.00 09012018 99999999 1 J8597 ANTIEMETIC DRUG ORAL NOS M 00000.00 04012021 99999999 1 S4989 PROGESTACERT IUD F 00095.98 07012013 99999999 1 S4993 CONTRACEPTIVE PILLS FOR BIRTH CONTROL/EA F 00000.92 07012013 99999999 1 T1013 SIGN LANGUAGE OR ORAL INTERP SERVICES F 00015.15 07012013 99999999 U T1013 TELEPHONIC INTERPRETIVE SERVICES F 00001.71 UC 07012013 99999999 1 T1999 MISCELLANEOUS THERAPEUTIC ITEMS AND SUPP M 00000.00 06112012 99999999 1 0429U HPV OROP SWAB 14 HI-RISK TYP M 00000.00 01012024 99999999 1 11976 REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSUL X 00073.81 04012021 99999999 1 11976 REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSUL F 00118.28 04012021 99999999 1 11981 INSERTION DRUG DLVR IMPLANT F 00113.09 04012021 99999999 1 11981 INSERTION DRUG DLVR IMPLANT X 00063.26 04012021 99999999 1 11982 REMOVAL,NON-BIO DRUG DELIVERY IMPLANT X 00077.42 04012021 99999999 1 11982 REMOVAL,NON-BIO DRUG DELIVERY IMPLANT F 00129.18 04012021 99999999 1 11983 REMOVAL W/REINSERT.NON-BIO DRUG IMPLANT F 00210.49 04012021 99999999 1 11983 REMOVAL W/REINSERT.NON-BIO DRUG IMPLANT X 00156.07 04012021 99999999 1 36415 ROUTINE VENIPUNCTURE FINGER/HEEL/EAR STI F 00003.33 03012023 99999999 1 36416 COLL. OF CAP.BLOOD SPECIMEN F 00003.33 04012021 99999999 1 36591 DRAW BLOOD OFF VENOUS DEVICE F 00017.43 04012021 99999999 1 36592 COLLECT BLOOD FROM PICC F 00021.57 04012021 99999999 1 36593 DECLOT VASCULAR DEVICE F 00027.43 04012021 99999999 1 43248 EGD GUIDE WIRE INSERTION F 00203.35 04012021 99999999 1 43248 EGD GUIDE WIRE INSERTION X 00181.02 04012021 99999999 1 55250 VASECTOMY,UNILATERAL/BILATERAL(SEPARATE X 00178.05 04012021 99999999 1 55250 VASECTOMY,UNILATERAL/BILATERAL(SEPARATE F 00315.61 04012021 99999999 1 55300 PREPARE SPERM DUCT X-RAY F 00205.50 04012021 99999999 1 56420 DRAINAGE OF GLAND ABSCESS F 00105.44 04012021 99999999 1 56420 DRAINAGE OF GLAND ABSCESS X 00074.50 04012021 99999999 1 56501 DESTROY VULVA LESIONS SIM X 00087.41 04012021 99999999 1 56501 DESTROY VULVA LESIONS SIM F 00105.51 04012021 99999999 1 56515 DESTROY VULVA LESION/S COMPL F 00158.57 04012021 99999999 1 56515 DESTROY VULVA LESION/S COMPL X 00133.75 04012021 99999999 1 56820 EXAM OF VULVA W/SCOPE X 00055.90 04012021 99999999 1 56820 EXAM OF VULVA W/SCOPE F 00076.41 04012021 99999999 1 56821 EXAM/BIOPSY OF VULVA W/SCOPE F 00098.75 04012021 99999999 1 56821 EXAM/BIOPSY OF VULVA W/SCOPE X 00073.42 04012021 99999999 1 57170 DIAPHRAGM OR CERVICAL CAP FITTING WITH I X 00047.49 04012021 99999999 1 57170 DIAPHRAGM OR CERVICAL CAP FITTING WITH I F 00062.36 04012021 99999999 1 57180 INTRO OF ANY HEMOSTATIC AGENT/PACK FOR S F 00106.25 04012021 99999999 1 57180 INTRO OF ANY HEMOSTATIC AGENT/PACK FOR S X 00075.60 04012021 99999999 1 57420 EXAM OF VAGINA W/SCOPE X 00056.68 04012021 99999999 1 57420 EXAM OF VAGINA W/SCOPE F 00076.41 04012021 99999999 1 57421 COLPOSCOPY OF THE ENTIRE VAGINA;W/BIOPSY F 00098.75 04012021 99999999 1 57421 COLPOSCOPY OF THE ENTIRE VAGINA;W/BIOPSY X 00074.01 04012021 99999999 1 57452 EXAM OF CERVIX W/SCOPE X 00083.58 04012021 99999999 1 57452 EXAM OF CERVIX W/SCOPE F 00076.41 04012021 99999999 1 57454 BX/CURETT OF CERVIX W/SCOPE F 00098.75 04012021 99999999 1 57454 BX/CURETT OF CERVIX W/SCOPE X 00123.52 04012021 99999999 1 57455 COLPOSCOPY OF THE CERVIX W/BIOPSY X 00100.37 04012021 99999999 1 57455 COLPOSCOPY OF THE CERVIX W/BIOPSY F 00076.41 04012021 99999999 1 57456 ENDOCERV CURETTAGE W/SCOPE F 00098.75 04012021 99999999 1 57456 ENDOCERV CURETTAGE W/SCOPE X 00093.24 04012021 99999999 1 57465 COMPUTER-AIDED MAPPING OF CERVIX UTERI D X 00038.99 01012021 99999999 1 57465 COMPUTER-AIDED MAPPING OF CERVIX UTERI D F 00050.83 01012021 99999999 1 57500 BIOPSY OF CERVIX F 00070.59 04012021 99999999 1 57500 BIOPSY OF CERVIX X 00039.96 04012021 99999999 1 57505 ENDOCERVICAL CURETTAGE(NOT DONE AS PART X 00073.18 04012021 99999999 1 57505 ENDOCERVICAL CURETTAGE(NOT DONE AS PART F 00085.56 04012021 99999999 1 57510 CAUTERIZATION OF CERVIX;ELECTRO OR THERM F 00132.08 04012021 99999999 1 57510 CAUTERIZATION OF CERVIX;ELECTRO OR THERM X 00110.03 04012021 99999999 1 57511 CRYOCAUTERY OF CERVIX X 00108.98 04012021 99999999 1 57511 CRYOCAUTERY OF CERVIX F 00126.67 04012021 99999999 1 57513 CAUTERIZATION OF CERVIX WITH LASER ABLAT F 00151.40 04012021 99999999 1 57513 CAUTERIZATION OF CERVIX WITH LASER ABLAT X 00132.37 04012021 99999999 1 57520 CONIZATION OF CERVIX X 00242.74 04012021 99999999 1 57520 CONIZATION OF CERVIX F 00285.31 04012021 99999999 1 57522 CONIZATION OF CERVIX F 00240.58 04012021 99999999 1 57522 CONIZATION OF CERVIX X 00222.22 04012021 99999999 1 58100 BIOPSY OF UTERUS LINING X 00045.01 04012021 99999999 1 58100 BIOPSY OF UTERUS LINING F 00058.83 04012021 99999999 1 58110 BX DONE W/COLPOSCOPY ADD-ON F 00058.83 04012021 99999999 1 58110 BX DONE W/COLPOSCOPY ADD-ON X 00047.73 04012021 99999999 1 58300 INSERT INTRAUTERINE DEVICE F 00076.12 09012018 99999999 1 58301 REMOVE INTRAUTERINE DEVICE F 00081.46 04012021 99999999 1 58301 REMOVE INTRAUTERINE DEVICE X 00055.09 04012021 99999999 1 58565 HYSTEROSCOPY STERILIZATION X 00380.76 04012021 99999999 1 58565 HYSTEROSCOPY STERILIZATION F 02026.44 04012021 99999999 1 58600 DIVISION OF FALLOPIAN TUBE F 00268.19 04012021 99999999 1 58605 LIGATION/TRANSECT FALLOPIAN TUBE(S)POSTP F 00237.25 04012021 99999999 1 58615 OCCLUDE FALLOPIAN TUBE(S) F 00254.81 04012021 99999999 1 76813 OB US NUCHAL MEAS 1 GEST F 00117.87 04012021 99999999 1 76813 OB US NUCHAL MEAS 1 GEST H 00063.09 TC 04012021 99999999 1 76813 OB US NUCHAL MEAS 1 GEST G 00054.78 26 04012021 99999999 1 76814 OB US NUCHAL MEAS ADD-ON G 00045.93 26 04012021 99999999 1 76814 OB US NUCHAL MEAS ADD-ON H 00032.29 TC 04012021 99999999 1 76814 OB US NUCHAL MEAS ADD-ON F 00078.22 04012021 99999999 1 76815 OB US LIMITED FETUS(S) F 00084.48 04012021 99999999 1 76815 OB US LIMITED FETUS(S) H 00050.90 TC 04012021 99999999 1 76815 OB US LIMITED FETUS(S) G 00033.58 26 04012021 99999999 1 76856 US EXAM PELVIC COMPLETE G 00035.30 26 04012021 99999999 1 76856 US EXAM PELVIC COMPLETE H 00054.52 TC 04012021 99999999 1 76856 US EXAM PELVIC COMPLETE F 00089.84 04012021 99999999 1 76857 US EXAM PELVIC LIMITED F 00057.42 04012021 99999999 1 76857 US EXAM PELVIC LIMITED H 00037.85 TC 04012021 99999999 1 76857 US EXAM PELVIC LIMITED G 00019.57 26 04012021 99999999 1 80074 ACUTE HEPATITIS PANEL F 00059.53 07012024 99999999 1 81000 UA, NON-AUTOMATED, WITH MICROSCOPY F 00004.73 04012021 99999999 1 81001 UA, AUTOMATED, WITH MICROSCOPY F 00004.73 04012021 99999999 1 81002 URINALYSIS WITHOUT MICROSCOPY, NON-AUTOM F 00003.83 03012023 99999999 1 81003 UA, AUTOMATED, WITHOUT MICROSCOPY F 00003.35 01012024 99999999 1 81025 URINE PREGNANCY TEST, BY VISUAL COLOR CO F 00009.45 03012023 99999999 1 81596 Biochemical assays for evaluation of chr F 00068.58 07012024 99999999 1 82948 GLUCOSE, BLOOD REAGENT STRIP F 00004.73 04012021 99999999 1 82962 GLUCOSE, BLOOD, BY GLUCOSE MONITOR. DEVI F 00004.73 03012023 99999999 1 84703 GONADOTROPIN, CHORIONIC; QUALITATIVE F 00011.23 01012024 99999999 1 85004 BLOOD COUNT AUTOMATED DIFF.WBC F 00009.69 04012021 99999999 1 85007 BLOOD COUNT,MANUAL DIFFERENTIAL WBC COUN F 00005.15 04012021 99999999 1 85013 BLOOD COUNT, SPIN MICROHEMATOCRIT F 00003.19 04012021 99999999 1 85014 BLOOD COUNT, OTHER THAN SPUN HEMATOCRIT F 00003.19 01012024 99999999 1 85018 BLOOD COUNT, HEMOGLOBIN, F 00003.19 01012024 99999999 1 86480 TB TEST; GAMMA INTERFERON F 00009.59 04012021 99999999 1 86481 TB TEST,CELL MEDIATED IMMUNITY ANTIGEN F 00088.09 04012021 99999999 1 86580 SKIN TEST; TUBERCULOSIS, INTRADERMAL F 00006.98 06012023 99999999 1 86689 HTLV 1, ANTIBODY DETECTION, CONFIRMATORY F 00010.17 04012021 99999999 1 86694 ANTIBODY, HERPES SIMPLEX, NON-SPECIFIC T F 00021.46 04012021 99999999 1 86701 ANTIBODY, HIV-1 F 00009.99 01012024 99999999 1 86702 ANTIBODY, HIV-2 F 00020.18 04012021 99999999 1 86703 ANTIBODY; HIV-1 & HIV-2,SINGLE RESULT F 00014.29 04012021 99999999 1 86704 HEPATITIS B CORE ANTIBODY(HBCAB);TOTAL F 00017.98 04012021 99999999 1 86705 HEPATITIS B IGM ANTIBODY F 00009.52 07012024 99999999 1 86706 HEPATITIS B SURFACE ANTIBODY (HBSAB) F 00016.02 04012021 99999999 1 86780 ANTIBODY; TREPONEMA PALLIDUM F 00012.70 01012024 99999999 1 86803 HEPATITIS C ANTIBODY F 00020.28 07012024 99999999 1 86804 HEPATITIS C ANTIBODY;CONFIRMATORY TEST F 00021.99 07012024 99999999 1 87102 CULTURE, FUNGI, ISOLATION; OTHER SOURCE F 00008.75 04012021 99999999 1 87110 CULTURE,CHLAMYDIA F 00029.31 04012021 99999999 1 87205 SMEAR, PRIMARY SOURCE W/ INTERPRETAT F 00006.38 04012021 99999999 1 87210 SMEAR, PRIMARY SOURCE W/ INTERPRETAT F 00006.38 01012024 99999999 1 87220 TISSUE EXAMINATION FOR FUNGI (EG, KOH SL F 00006.38 04012021 99999999 1 87252 VIRUS ISOLATION;TISSUE CULTURE INOCUL F 00038.87 04012021 99999999 1 87340 INFECTIOUS AGENT DETECTION; HBSAG F 00014.42 04012021 99999999 1 87341 HEP B SURFACE AG NEUTRLZJ IA F 00013.73 07012024 99999999 1 87389 HIV-1 AG W/HIV-1&-2 AB AG IA F 00023.16 01012024 99999999 1 87390 HIV-1 AG IA F 00019.95 04012021 99999999 1 87467 HEPATITIS B SURFACE AG QUAN F 00014.30 01012023 99999999 1 87491 CHLMYD TRACH DNA AMP PROBE F 00035.44 07012023 99999999 1 87516 INFECTIOUS AGENT DETECT; HEPATITIS B F 00049.86 07012024 99999999 1 87517 INFECTIOUS AGENT DETECT; HEPATITIS B F 00060.87 07012024 99999999 1 87520 INFECTIOUS AGENT DETECT;HEPATITIS C F 00028.49 07012024 99999999 1 87521 INFECTIOUS AGENT DETECT;HEPATITIS C F 00049.86 07012024 99999999 1 87522 INFECTIOUS AGENT DETECT;HEPATITIS C F 00060.87 07012024 99999999 1 87534 INFECTIOUS AGENT DETECTION; HIV-1 F 00029.91 04012021 99999999 1 87535 INFECTIOUS AGENT DETECTION; HIV-1 F 00052.35 04012021 99999999 1 87536 INFECTIOUS AGENT DETECTION; HIV-1 F 00126.93 04012021 99999999 1 87563 Detection of Mycoplasma genitalium by DN F 00033.34 04012021 99999999 1 87591 INFECTIOUS AGENT DETECTION; NEISSERIA F 00035.44 07012023 99999999 1 87623 DETECTION TEST FOR HUMAN PAPILLOMAVIRUS F 00048.24 04012021 99999999 1 87624 DETECTION TEST FOR HUMAN PAPILLOMAVIRUS F 00048.24 04012021 99999999 1 87625 DETECTION TEST FOR HUMAN PAPILLOMAVIRUS F 00048.24 04012021 99999999 1 87660 INFECTIOUS AGENT DETECT; TRICHOMONAS F 00029.34 04012021 99999999 1 87661 MYCOBACTERIA AVIUM-INTRACELL,AMPLIFIED F 00048.23 04012021 99999999 1 87798 INFECTIOUS AGENT DETECTION;NOS; AMPLIF F 00052.35 04012021 99999999 1 87806 HIV AG W/HIV1&2 ANTB W/OPTIC F 00020.99 01012024 99999999 1 87902 Nfct agt gntyp alys hep c F 00365.77 07012024 99999999 1 87912 Nfct agt gntyp alys hep b F 00339.55 07012024 99999999 1 88305 LEVEL IV SURGICAL PATHOLOGY, GROSS & MIC F 00074.48 04012021 99999999 1 88305 LEVEL IV SURGICAL PATHOLOGY, GROSS & MIC H 00029.43 TC 04012021 99999999 1 88305 LEVEL IV SURGICAL PATHOLOGY, GROSS & MIC G 00045.06 26 04012021 99999999 1 88307 LEVEL V SURGICAL PATHOLOGY, GROSS & MICR F 00151.08 04012021 99999999 1 88738 HGB, QUANTITATIVE, TRANSCUTANEOUS F 00007.26 04012021 99999999 1 89321 SEMEN ANALYSIS F 00017.72 01012024 99999999 1 90460 IM ADMIN 1ST/ONLY COMPONENT F 00022.00 04012021 99999999 1 90460 IM ADMIN 1ST/ONLY COMPONENT W 00019.68 04012021 99999999 1 90461 IM ADMIN EACH ADDL COMPONENT F 00011.06 04012021 99999999 1 90471 IMMUNIZATION ADMIN F 00005.35 03012023 99999999 1 90472 IMMUNIZATION ADMIN EACH ADD F 00005.35 03012023 99999999 1 90473 IMMUNE ADMIN ORAL/NASAL F 00013.56 04012021 99999999 1 90474 IMMUNE ADMIN ORAL/NASAL ADDL F 00007.23 04012021 99999999 1 90480 IMMUNIZATION ADMINISTRATION OF SARS-COV- F 00005.09 10012024 99999999 1 90611 SMALLPOX&MONKEYPOX VAC 0.5ML F 00000.00 07262022 99999999 1 90619 MENACWY-TT VACCINE IM F 00157.98 06012023 99999999 1 90620 MENB-4C VACCINE IM F 00213.90 03012024 99999999 1 90621 MENB-FHBP VACC 2/3 DOSE IM F 00181.87 03012024 99999999 1 90622 VACCINIA VRS VAC 0.3 ML PERQ F 00000.00 07262022 99999999 1 90649 4VHPV VACCINE 3 DOSE IM F 00153.01 10012021 99999999 1 90650 2VHPV VACCINE 3 DOSE IM M 00000.00 09012018 99999999 1 90651 9VHPV VACCINE 2/3 DOSE IM F 00291.09 03012024 99999999 1 90674 CCIIV4 VAC NO PRSV 0.5 ML IM F 00030.36 03012024 99999999 1 90681 RV1 VACC 2 DOSE LIVE ORAL F 00136.32 03012024 99999999 1 90682 RIV4 VACC RECOMBINANT DNA IM F 00065.21 03012024 99999999 1 90689 VACC IIV4 NO PRSRV 0.25ML IM M 00000.00 04012021 99999999 1 90694 VACC AIIV4 NO PRSRV 0.5ML IM F 00068.73 04012024 99999999 1 90750 HZV VACC RECOMBINANT IM F 00200.42 07012024 99999999 1 90756 CCIIV4 VACC ABX FREE IM F 00028.76 03012024 99999999 1 90863 MANAGEMENT OF PRESCRIPTIONS & REVIEW OF M 00000.00 09012018 99999999 1 91304 SARSCOV2 VAC 5MCG/0.5ML IM F 00148.02 03012024 99999999 1 91318 SARS-COV-2 COVID-19 VACCINE, 3 MCG/0.3 M F 00065.36 09112023 99999999 1 91319 SARS-COV-2 COVID-19 VACCINE, 10 MCG/0.3 F 00087.78 09112023 99999999 1 91320 SARS-COV-2 COVID-19 VACCINE, 30 MCG/0.3 F 00131.10 09112023 99999999 1 91321 SARS-COV-2 COVID-19 VACCINE, 25 MCG/0.25 F 00145.92 09112023 99999999 1 91322 SARS-COV-2 COVID-19 VACCINE, 50 MCG/0.5 F 00145.92 09112023 99999999 1 96160 ADMIN & INTERPRETATION OF PATIENT-FOCUSE F 00008.19 05012020 99999999 1 96161 ADMIN & INTERPRETATION OF CAREGIVER-FOCU F 00008.19 01012017 99999999 1 96372 THER/PROPH/DIAG INJ SC/IM F 00003.97 04012021 99999999 1 99000 HANDLING AND/OR CONVEYANCE OF SPECIMEN, F 00003.33 01012024 99999999 1 99001 HANDLING AND/OR CONVEYANCE OF SPECIMEN, F 00005.54 01012024 99999999 1 99202 OFFICE O/P NEW SF 15 MIN F 00060.86 01012024 99999999 1 99202 OFFICE O/P NEW SF 15 MIN X 00039.18 01012024 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN X 00058.03 01012024 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN F 00085.65 01012024 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN 9 00050.17 AF 01012016 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN 9 00036.94 SA 01012016 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN 9 00036.94 U2 01012016 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN 9 00032.83 TD 01012016 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN X 00023.41 TD 01012018 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN X 00026.34 SA 01012018 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN X 00026.34 U2 01012018 99999999 1 99203 OFFICE O/P NEW LOW 30 MIN X 00035.78 AF 01012018 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN 9 00059.41 U2 01012016 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN 9 00063.12 SA 01012016 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN 9 00074.26 AF 01012016 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN X 00047.49 U2 07012017 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN X 00050.46 SA 07012017 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN X 00059.36 AF 07012017 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN F 00124.02 01012024 99999999 1 99204 OFFICE O/P NEW MOD 45 MIN X 00093.00 01012024 99999999 1 99205 OFFICE O/P NEW HI 60 MIN X 00120.31 01012024 99999999 1 99205 OFFICE O/P NEW HI 60 MIN F 00154.62 01012024 99999999 1 99205 OFFICE O/P NEW HI 60 MIN X 00054.74 U2 01012018 99999999 1 99205 OFFICE O/P NEW HI 60 MIN X 00058.16 SA 01012018 99999999 1 99205 OFFICE O/P NEW HI 60 MIN X 00068.42 AF 01012018 99999999 1 99205 OFFICE O/P NEW HI 60 MIN 9 00083.54 AF 01012016 99999999 1 99205 OFFICE O/P NEW HI 60 MIN 9 00066.83 U2 01012016 99999999 1 99205 OFFICE O/P NEW HI 60 MIN 9 00071.01 SA 01012016 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP 9 00012.16 TD 01012016 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP 9 00013.68 SA 01012016 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP 9 00013.68 U2 01012016 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP X 00005.26 TD 01012018 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP X 00005.92 SA 01012018 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP X 00005.92 U2 01012018 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP X 00008.04 AF 01012018 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP 9 00018.58 AF 01012016 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP F 00019.05 04012021 99999999 1 99211 OFF/OP EST MAY X REQ PHY/QHP X 00007.83 04012021 99999999 1 99212 OFFICE O/P EST SF 10 MIN X 00018.33 01012024 99999999 1 99212 OFFICE O/P EST SF 10 MIN F 00033.00 01012024 99999999 1 99212 OFFICE O/P EST SF 10 MIN 9 00032.52 AF 01012016 99999999 1 99212 OFFICE O/P EST SF 10 MIN X 00012.44 TD 01012018 99999999 1 99212 OFFICE O/P EST SF 10 MIN X 00013.99 SA 01012018 99999999 1 99212 OFFICE O/P EST SF 10 MIN X 00013.99 U2 01012018 99999999 1 99212 OFFICE O/P EST SF 10 MIN X 00019.01 AF 01012018 99999999 1 99212 OFFICE O/P EST SF 10 MIN 9 00021.28 TD 01012016 99999999 1 99212 OFFICE O/P EST SF 10 MIN 9 00023.94 SA 01012016 99999999 1 99212 OFFICE O/P EST SF 10 MIN 9 00023.94 U2 01012016 99999999 1 99213 OFFICE O/P EST LOW 20 MIN 9 00030.40 TD 01012016 99999999 1 99213 OFFICE O/P EST LOW 20 MIN 9 00034.20 SA 01012016 99999999 1 99213 OFFICE O/P EST LOW 20 MIN 9 00034.20 U2 01012016 99999999 1 99213 OFFICE O/P EST LOW 20 MIN X 00021.52 TD 01012018 99999999 1 99213 OFFICE O/P EST LOW 20 MIN X 00024.21 SA 01012018 99999999 1 99213 OFFICE O/P EST LOW 20 MIN X 00024.21 U2 01012018 99999999 1 99213 OFFICE O/P EST LOW 20 MIN X 00032.88 AF 01012018 99999999 1 99213 OFFICE O/P EST LOW 20 MIN 9 00046.45 AF 01012016 99999999 1 99213 OFFICE O/P EST LOW 20 MIN F 00045.51 01012024 99999999 1 99213 OFFICE O/P EST LOW 20 MIN X 00030.61 01012024 99999999 1 99214 OFFICE O/P EST MOD 30 MIN X 00049.07 01012024 99999999 1 99214 OFFICE O/P EST MOD 30 MIN F 00070.31 01012024 99999999 1 99214 OFFICE O/P EST MOD 30 MIN 9 00050.17 AF 01012016 99999999 1 99214 OFFICE O/P EST MOD 30 MIN X 00024.11 TD 01012018 99999999 1 99214 OFFICE O/P EST MOD 30 MIN X 00027.13 SA 01012018 99999999 1 99214 OFFICE O/P EST MOD 30 MIN X 00027.13 U2 01012018 99999999 1 99214 OFFICE O/P EST MOD 30 MIN X 00036.85 AF 01012018 99999999 1 99214 OFFICE O/P EST MOD 30 MIN 9 00032.83 TD 01012016 99999999 1 99214 OFFICE O/P EST MOD 30 MIN 9 00036.94 SA 01012016 99999999 1 99214 OFFICE O/P EST MOD 30 MIN 9 00036.94 U2 01012016 99999999 1 99215 OFFICE O/P EST HI 40 MIN 9 00059.41 U2 01012016 99999999 1 99215 OFFICE O/P EST HI 40 MIN 9 00063.12 SA 01012016 99999999 1 99215 OFFICE O/P EST HI 40 MIN X 00045.71 U2 01012018 99999999 1 99215 OFFICE O/P EST HI 40 MIN X 00048.57 SA 01012018 99999999 1 99215 OFFICE O/P EST HI 40 MIN X 00057.14 AF 01012018 99999999 1 99215 OFFICE O/P EST HI 40 MIN 9 00074.26 AF 01012016 99999999 1 99215 OFFICE O/P EST HI 40 MIN F 00105.22 01012024 99999999 1 99215 OFFICE O/P EST HI 40 MIN X 00076.90 01012024 99999999 1 99341 Home/res vst new sf mdm 15 F 00047.29 03012023 99999999 1 99341 Home/res vst new sf mdm 15 9 00125.00 TG 01012016 99999999 1 99342 Home/res vst new low mdm 30 F 00075.44 03012023 99999999 1 99344 Home/res vst new mod mdm 60 F 00138.32 03012023 99999999 1 99345 Home/res vst new high mdm 75 F 00194.19 03012023 99999999 1 99347 Home/res vst est sf mdm 20 F 00043.24 03012023 99999999 1 99348 Home/res vst est low mdm 30 F 00073.42 03012023 99999999 1 99349 Home/res vst est mod mdm 40 F 00122.21 03012023 99999999 1 99350 Home/res vst est high mdm 60 F 00178.38 03012023 99999999 1 99383 PREV VISIT NEW AGE 5-11 F 00099.55 01012024 99999999 1 99383 PREV VISIT NEW AGE 5-11 Q 00098.57 01012024 99999999 1 99383 PREV VISIT NEW AGE 5-11 R 00098.57 01012024 99999999 1 99384 PREV VISIT NEW AGE 12-17 Q 00109.70 01012024 99999999 1 99384 PREV VISIT NEW AGE 12-17 R 00109.70 01012024 99999999 1 99384 PREV VISIT NEW AGE 12-17 F 00110.79 01012024 99999999 1 99385 PREV VISIT NEW AGE 18-39 F 00107.41 01012024 99999999 1 99385 PREV VISIT NEW AGE 18-39 Q 00106.35 01012024 99999999 1 99385 PREV VISIT NEW AGE 18-39 R 00106.35 01012024 99999999 1 99386 PREV VISIT NEW AGE 40-64 F 00129.36 01012024 99999999 1 99393 PREV VISIT EST AGE 5-11 F 00083.79 01012024 99999999 1 99393 PREV VISIT EST AGE 5-11 Q 00082.97 01012024 99999999 1 99393 PREV VISIT EST AGE 5-11 R 00082.97 01012024 99999999 1 99394 PREV VISIT EST AGE 12-17 Q 00093.87 01012024 99999999 1 99394 PREV VISIT EST AGE 12-17 R 00093.87 01012024 99999999 1 99394 PREV VISIT EST AGE 12-17 F 00094.80 01012024 99999999 1 99395 PREV VISIT EST AGE 18-39 F 00092.43 01012024 99999999 1 99395 PREV VISIT EST AGE 18-39 Q 00091.52 01012024 99999999 1 99395 PREV VISIT EST AGE 18-39 R 00091.52 01012024 99999999 1 99396 PREV VISIT EST AGE 40-64 F 00103.02 01012024 99999999 1 99401 PREVENTIVE COUNSELING INDIV F 00015.34 12012021 99999999 1 99402 PREVENTIVE COUNSELING INDIV F 00021.01 09012018 99999999 1 99403 PREVENTIVE COUNSELING INDIV F 00035.98 07012013 99999999 1 99404 PREVENTIVE COUNSELING INDIV F 00042.46 07012013 99999999 1 99408 ALCOHL/SUB ABUSE SCRN&INTERV,15-30MIN F 00035.67 09012018 99999999 1 99417 Prolng op e/m each 15 min F 00028.19 08012022 99999999