{"text_format":"3","workbook":"xlsx","n_sheets":1,"sheets":["363617578_Langdon-Prairie-Healt"],"read":"whole","date_system":"1900"}

{"sheet":"363617578_Langdon-Prairie-Healt","index":0,"n_rows":48345,"n_cols":30,"rows_kept":4500,"cut":true,"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["hospital_name","last_updated_on","version","hospital_location","hospital_address","license_number | ND","To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated."]
["Langdon Prairie Health","2025-07-17","2.0.0","Langdon Prairie Health","909 Second Street, Langdon, ND  58249",5029,true]
["description","code | 1","code | 1 | type","code | 2","code | 2 | type","code | 3","code | 3 | type","code | 4","code | 4 | type","code | 5","code | 5 | type","code | 6","code | 6 | type","setting","drug_unit_of_measurement","drug_type_of_measurement","standard_charge | gross","standard_charge | discounted_cash","payer_name","plan_name","modifiers","standard_charge | negotiated_dollar","standard_charge | negotiated_percentage","standard_charge | negotiated_algorithm","estimated_amount","standard_charge | min","standard_charge | max","standard_charge | methodology","additional_generic_notes","billing_class"]
["Cltx Dstl Rdl Fx/Epiphysl Sep W/Mnpj","PX-25605","CDM",25605,"CPT",982,"RC",{"$nulls":6},"both",null,null,1569.66,1569.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},497.77,528.88,null,null,"facility"]
["Closed Tx Carpal Scaphoid Fracture W/O Mnpj","PX-25622","CDM",25622,"CPT",982,"RC",{"$nulls":6},"both",null,null,917.73,917.73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},283.7,308.25,null,null,"facility"]
["Drainage Finger Abscess Simple","PX-26010","CDM",26010,"CPT",982,"RC",{"$nulls":6},"both",null,null,1001.31,1001.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},136.53,334.96,null,null,"facility"]
["Exc Lesion Tdn Shth/Jt Capsl Hand/Fngr","PX-26160","CDM",26160,"CPT",982,"RC",{"$nulls":6},"both",null,null,1785.84,1785.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},308.17,598.29,null,null,"facility"]
["Manipulation Finger Joint Under Anes Each Joint","PX-26340","CDM",26340,"CPT",982,"RC",{"$nulls":6},"both",null,null,1053.39,1053.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},353.6,353.6,null,null,"facility"]
["HC Surgical Path-Level III","PX-401536007","CDM",88304,"CPT",312,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgical Path-Level II","PX-401536030","CDM",88302,"CPT",312,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgical Path-Level V","PX-401536047","CDM",88307,"CPT",312,"RC",{"$nulls":6},"both",null,null,1027.44,1027.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Special Stain-Group I","PX-401536070","CDM",88312,"CPT",312,"RC",{"$nulls":6},"both",null,null,160.29,160.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgical Path-Level VI","PX-401536087","CDM",88309,"CPT",312,"RC",{"$nulls":6},"both",null,null,2457.87,2457.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgical Path-Level I","PX-401536120","CDM",88300,"CPT",312,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cltx Carpo/Metacarpal Dislocation Thumb W/Manj","PX-26641","CDM",26641,"CPT",982,"RC",{"$nulls":6},"both",null,null,1233.66,1233.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},376.71,415.35,null,null,"facility"]
["Cltx Metacarpophalangeal Dislc W/Manj W/O Anes","PX-26700","CDM",26700,"CPT",982,"RC",{"$nulls":6},"both",null,null,999.06,999.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},308.87,336.38,null,null,"facility"]
["Cltx Phlngl Fx Prox/Middle Px/F/T W/Manj Ea","PX-26725","CDM",26725,"CPT",982,"RC",{"$nulls":6},"both",null,null,1010.19,1010.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},301.14,339.78,null,null,"facility"]
["Cltx Iphal Jt Dislc W/Manj W/O Anes","PX-26770","CDM",26770,"CPT",982,"RC",{"$nulls":6},"both",null,null,854.31,854.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},260.33,287.51,null,null,"facility"]
["HC Treat Knee Dislocation","PX-4902408","CDM",27552,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Partial Removal of Colon","PX-4902415","CDM",44140,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair Ing Hernia,Slidin","PX-4902420","CDM",49525,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Amp F/Th 1/2 Jt/Phalanx W/Neurect W/Dir Clsr","PX-26951","CDM",26951,"CPT",982,"RC",{"$nulls":6},"both",null,null,2029.32,2029.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},681.75,681.75,null,null,"facility"]
["HC Ultrasound of Extremity","PX-4020077","CDM",76881,"CPT",402,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Inject Si Joint Arthrgrphy&/Anes/Steroid W/Ima","PX-27096","CDM",27096,"CPT",982,"RC",{"$nulls":6},"both",null,null,475.8,475.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},78.66,159.21,null,null,"facility"]
["Tx Spon Hip Dislc Abdct Splnt/Trcj W/Manj Anes","PX-27257","CDM",27257,"CPT",982,"RC",{"$nulls":6},"both",null,null,1004.1,1004.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},339.7,339.7,null,null,"facility"]
["Cltx Post Hip Arthrp Dislc W/O Anes","PX-27265","CDM",27265,"CPT",982,"RC",{"$nulls":6},"both",null,null,1199.82,1199.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},404.85,404.85,null,null,"facility"]
["Removal Foreign Body Deep Thigh/Knee","PX-27372","CDM",27372,"CPT",982,"RC",{"$nulls":6},"both",null,null,1674.27,1674.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},381.6,563,null,null,"facility"]
["Njx Aa&/Strd Plantar Common Digital Nerves","PX-64455","CDM",64455,"CPT",975,"RC",{"$nulls":6},"both",null,null,143.7,143.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},31.47,48.17,null,null,"facility"]
["Therapeutic Prophylactic/Dx Injection Subq/Im","PX-96372","CDM",96372,"CPT",982,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},11.83,13.92,null,null,"facility"]
["Ambulance Non-Emergent","PX-5420012","CDM","A0426","HCPCS",542,"RC",{"$nulls":6},"both",null,null,1009.32,1009.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Behavior Counsel Obesity 15m","PX-LHG0447","CDM","G0447","HCPCS",942,"RC",{"$nulls":6},"both",null,null,277.5,277.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Glucose 6 Phosphate Quantitative","PX-LH300790","CDM",82955,"CPT",300,"RC",{"$nulls":6},"both",null,null,80,80,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Closed Tx Knee Dislocation W/Anesthesia","PX-27552","CDM",27552,"CPT",982,"RC",{"$nulls":6},"both",null,null,1805.31,1805.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},609.15,609.15,null,null,"facility"]
["Lh Shbg","PX-LH300791","CDM",84270,"CPT",300,"RC",{"$nulls":6},"both",null,null,171,171,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Closed Tx Patellar Dislocation W/O Anesthesia","PX-27560","CDM",27560,"CPT",982,"RC",{"$nulls":6},"both",null,null,1096.59,1096.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},335.43,369.16,null,null,"facility"]
["Rbc's Washed","PX-402534200","CDM","P9022","HCPCS",390,"RC",{"$nulls":6},"both",null,null,1191.36,1191.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Thoracentesis Needle/Cath Pleura W/O Imaging","PX-32554","CDM",32554,"CPT",982,"RC",{"$nulls":6},"both",null,null,675.87,675.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},82.14,226.22,null,null,"facility"]
["Perq Drainage Pleura Insert Cath W/O Imaging","PX-32556","CDM",32556,"CPT",982,"RC",{"$nulls":6},"both",null,null,2148.48,2148.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},113.99,717.8,null,null,"facility"]
["Chemodervate Facial/Trigem/Cerv Musc Migraine","PX-64615","CDM",64615,"CPT",975,"RC",{"$nulls":6},"both",null,null,417.54,417.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},111.19,141.97,null,null,"facility"]
["Cltx Tibial Shaft Fx W/Manj W/WO Skel Tracj","PX-27752","CDM",27752,"CPT",982,"RC",{"$nulls":6},"both",null,null,1547.43,1547.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},474.04,521.51,null,null,"facility"]
["Cltx Prox Fibula/Shft Fx W/O Manj","PX-27780","CDM",27780,"CPT",982,"RC",{"$nulls":6},"both",null,null,919.08,919.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},283.54,308.75,null,null,"facility"]
["Cltx Dstl Fibular Fx Lat Malls W/O Manj","PX-27786","CDM",27786,"CPT",975,"RC",{"$nulls":6},"both",null,null,929.91,929.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cltx Dstl Fibular Fx Lat Malls W/Manj","PX-27788","CDM",27788,"CPT",982,"RC",{"$nulls":6},"both",null,null,1244.37,1244.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},376.9,419.14,null,null,"facility"]
["Closed Tx Bimalleolar Ankle Fracture W/Manj","PX-27810","CDM",27810,"CPT",982,"RC",{"$nulls":6},"both",null,null,1383.12,1383.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},417.12,465.91,null,null,"facility"]
["Cltx Trimalleolar Ankle Fx W/Manipulation","PX-27818","CDM",27818,"CPT",982,"RC",{"$nulls":6},"both",null,null,1432.92,1432.92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},427.8,482.81,null,null,"facility"]
["Closed Tx Ankle Dislocation W/O Anesthesia","PX-27840","CDM",27840,"CPT",982,"RC",{"$nulls":6},"both",null,null,1119.9,1119.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},377.59,377.59,null,null,"facility"]
["HC Drain/Inj Major Joint/Bursa W/US","PX-4902720","CDM",20611,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Removal Foreign Body Foot Subcutaneous","PX-28190","CDM",28190,"CPT",982,"RC",{"$nulls":6},"both",null,null,697.11,697.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},127.81,233.25,null,null,"facility"]
["Electrocardiogram,Complet Ippe","PX-G0403","CDM","G0403","CPT",985,"RC",{"$nulls":6},"both",null,null,41.04,41.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},13.76,13.76,null,null,"facility"]
["HC Knee Min 3 Views Bilateral","PX-3200234","CDM",73562,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Fetal Biopsy Profile","PX-4020040","CDM",76818,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cltx Tarsal Dislc Oth/Thn Talotarsal W/O Anes","PX-28540","CDM",28540,"CPT",982,"RC",{"$nulls":6},"both",null,null,583.98,583.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},175.11,195.41,null,null,"facility"]
["Cltx Metatarsophlngl Jt Dislc W/O Anes","PX-28630","CDM",28630,"CPT",521,"RC",{"$nulls":6},"both",null,null,448.26,448.26,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},106.08,150.61,null,null,"facility"]
["HC Aspirate Pleura W/O Imaging","PX-4902461","CDM",32554,"CPT",360,"RC",{"$nulls":6},"both",null,null,1854.78,1854.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Thyroid Uptake Measurement","PX-3410084","CDM",78012,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Thyroid Imaging W/Blood Flow","PX-3410085","CDM",78013,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Thyroid Imaging","PX-3410086","CDM",78014,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Manual Wbc Differential","PX-401585007","CDM",85007,"CPT",305,"RC",{"$nulls":6},"both",null,null,28,28,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pap Smear (Tl), Screen","PX-4015G0123","CDM","G0123","HCPCS",311,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pap Smear (Tl)","PX-401588142","CDM",88142,"CPT",311,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgical Path-Level IV","PX-401536027","CDM",88305,"CPT",312,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Immunoperoxidase Stain","PX-401536078","CDM",88342,"CPT",312,"RC",{"$nulls":6},"both",null,null,514.08,514.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Special Stain - Group II","PX-401536160","CDM",88313,"CPT",312,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Application Cast Shoulder Hand Long Arm","PX-29065","CDM",29065,"CPT",982,"RC",{"$nulls":6},"both",null,null,282.42,282.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},64.76,94.89,null,null,"facility"]
["Application Cast Elbow Finger Short Arm","PX-29075","CDM",29075,"CPT",982,"RC",{"$nulls":6},"both",null,null,255.15,255.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},59.51,85.71,null,null,"facility"]
["Application Long Arm Splint Shoulder Hand","PX-29105","CDM",29105,"CPT",982,"RC",{"$nulls":6},"both",null,null,239.79,239.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},38.4,80.64,null,null,"facility"]
["Application Short Arm Splint Forearm-Hand Static","PX-29125","CDM",29125,"CPT",982,"RC",{"$nulls":6},"both",null,null,195.9,195.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},38.52,65.7,null,null,"facility"]
["Application Finger Splint Static","PX-29130","CDM",29130,"CPT",982,"RC",{"$nulls":6},"both",null,null,120.27,120.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},27.06,40.49,null,null,"facility"]
["Strapping Elbow/Wrist","PX-29260","CDM",29260,"CPT",982,"RC",{"$nulls":6},"both",null,null,83.64,83.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},17.86,28.01,null,null,"facility"]
["Strapping Hand/Finger","PX-29280","CDM",29280,"CPT",982,"RC",{"$nulls":6},"both",null,null,85.38,85.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},18.86,28.68,null,null,"facility"]
["Application Long Leg Cast Thigh-Toe","PX-29345","CDM",29345,"CPT",982,"RC",{"$nulls":6},"both",null,null,389.91,389.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},93.47,131.12,null,null,"facility"]
["Application Short Leg Cast Below Knee-Toe","PX-29405","CDM",29405,"CPT",982,"RC",{"$nulls":6},"both",null,null,233.76,233.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.9,78.49,null,null,"facility"]
["Application Short Leg Cast Walking/Ambulatory","PX-29425","CDM",29425,"CPT",982,"RC",{"$nulls":6},"both",null,null,219.87,219.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},51.79,73.73,null,null,"facility"]
["Influenza A H1N1,admin w cou","PX-G9141","CDM","G9141","HCPCS",982,"RC",{"$nulls":6},"both",null,null,95.76,95.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Application Short Leg Splint Calf Foot","PX-29515","CDM",29515,"CPT",982,"RC",{"$nulls":6},"both",null,null,210.42,210.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},47.38,70.62,null,null,"facility"]
["Strapping Unna Boot","PX-29580","CDM",29580,"CPT",982,"RC",{"$nulls":6},"both",null,null,184.35,184.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},24.43,61.76,null,null,"facility"]
["Removal/Bivalving Full Arm/Full Leg Cast","PX-29705","CDM",29705,"CPT",982,"RC",{"$nulls":6},"both",null,null,181.32,181.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},41.65,60.97,null,null,"facility"]
["Ht Muscle Image Spect,Multiple","PX-3410073","CDM",78452,"CPT",341,"RC",{"$nulls":6},"both",null,null,3916.44,3916.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh PCP","PX-LH300832","CDM",83992,"CPT",300,"RC",{"$nulls":6},"both",null,null,176.09,176.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cocaine","PX-LH300833","CDM",80353,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tricyclic Anti Depressants","PX-LH300834","CDM",80335,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aspergillus Fumigatus (M3) Ige","PX-LH300831","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hypersensitivity Pneumonitis Eval Igg","PX-LH300830","CDM",86609,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 1 Level","PX-64490","CDM",64490,"CPT",975,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},99.97,186.74,null,null,"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 2nd Level","PX-64491","CDM",64491,"CPT",975,"RC",{"$nulls":6},"both",null,null,1548.97,1548.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.73,93.72,null,null,"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 3+ Level","PX-64492","CDM",64492,"CPT",975,"RC",{"$nulls":6},"both",null,null,1443.02,1443.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},56.71,94.04,null,null,"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level","PX-64493","CDM",64493,"CPT",975,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},86.04,172.15,null,null,"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 2nd Level","PX-64494","CDM",64494,"CPT",975,"RC",{"$nulls":6},"both",null,null,2721.55,2721.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},47.86,87.81,null,null,"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level","PX-64495","CDM",64495,"CPT",975,"RC",{"$nulls":6},"both",null,null,2966.52,2966.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},48.84,87.81,null,null,"facility"]
["Myocardial Spect Multiple Studies","PX-78452","CDM",78452,"CPT",972,"RC",{"$nulls":6},"both",null,null,4058.79,4058.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},72.07,72.07,null,null,"facility"]
["Lh Fecal Fat,Total Quant","PX-LH300796","CDM",82710,"CPT",300,"RC",{"$nulls":6},"both",null,null,129,129,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Removal Foreign Body Intranasal Office Procedure","PX-30300","CDM",30300,"CPT",982,"RC",{"$nulls":6},"both",null,null,613.08,613.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},119.28,205.07,null,null,"facility"]
["Control Nasal Hemorrhage Anterior Simple","PX-30901","CDM",30901,"CPT",982,"RC",{"$nulls":6},"both",null,null,450.15,450.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.33,150.89,null,null,"facility"]
["Control Nasal Hemorrhage Anterior Complex","PX-30903","CDM",30903,"CPT",982,"RC",{"$nulls":6},"both",null,null,703.29,703.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},71.2,235.58,null,null,"facility"]
["Ctrl Nsl Hemrrg Pst Nasal Packs&/Cautery 1st","PX-30905","CDM",30905,"CPT",982,"RC",{"$nulls":6},"both",null,null,1011.18,1011.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},97.94,338.61,null,null,"facility"]
["Ctrl Nsl Hemrrg Pst Nasal Packs&/Cautery Subsq","PX-30906","CDM",30906,"CPT",982,"RC",{"$nulls":6},"both",null,null,1083.78,1083.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},123.34,363.03,null,null,"facility"]
["Tte W/WO Fol W/Con Doppler","PX-4800088","CDM","C8929","HCPCS",483,"RC",{"$nulls":6},"both",null,null,2370.18,2370.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Respite Hospice","PX-6550101","CDM",6550101,"LOCAL",655,"RC",{"$nulls":6},"both",null,null,1300,1300,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dietician Consult","PX-LH97805","CDM","LH97805","LOCAL",942,"RC",{"$nulls":6},"both",null,null,300,300,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mercury Quant","PX-LH300797","CDM",83825,"CPT",300,"RC",{"$nulls":6},"both",null,null,126,126,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Screen Only","PX-LH300792","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Intubation Endotracheal Emergency Procedure","PX-31500","CDM",31500,"CPT",982,"RC",{"$nulls":6},"both",null,null,383.52,383.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},129.74,129.74,null,null,"facility"]
["Lh Serum by Red Cell Absorption,Each","PX-LH300800","CDM",86978,"CPT",300,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antibody ID,RBC Ea Panel Ea Ser Techniq","PX-LH300801","CDM",86870,"CPT",300,"RC",{"$nulls":6},"both",null,null,488.22,488.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Direct Antihuman Globulin,Each","PX-LH300802","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antibody Elution,Each","PX-LH300803","CDM",86860,"CPT",300,"RC",{"$nulls":6},"both",null,null,488.22,488.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Extended Phenotype (Unit X 9)","PX-LH300804","CDM",86905,"CPT",300,"RC",{"$nulls":6},"both",null,null,11.49,11.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Red Cell Pre-Treatment,Each","PX-LH300805","CDM",86970,"CPT",300,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rh Phenotyping,Complete","PX-LH300806","CDM",86906,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.25,23.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC CT Tobacco Hx Chest","PX-3521000","CDM",71250,"CPT",352,"RC",{"$nulls":6},"both",null,null,1287,1287,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Norovirus Rna Amp Stool","PX-LH300807","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Port&Line Draw","PX-LH300838","CDM",36591,"CPT",300,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Capillary Draw","PX-LH300839","CDM",36416,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.82,35.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Mycobacterium Tuberculosis","PX-LH300837","CDM",87556,"CPT",300,"RC",{"$nulls":6},"both",null,null,125.04,125.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Methylmalonic Acid","PX-LH300840","CDM",83921,"CPT",300,"RC",{"$nulls":6},"both",null,null,135,135,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Casein (F78) Igg","PX-LH300841","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Allergen Gluten Igg","PX-LH300842","CDM",86001,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bordetella Pertussis Pcr Amp","PX-LH300794","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bordetella Pertussis Culture","PX-LH300793","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetone,Blood Quant","PX-LH300799","CDM",82010,"CPT",300,"RC",{"$nulls":6},"both",null,null,63,63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Super Saturation Profile/Urine 24hr","PX-LH300798","CDM","LH300798","LOCAL",300,"RC",{"$nulls":6},"both",null,null,805,805,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Strep Pneumoniae Igg","PX-LH300844","CDM",86317,"CPT",300,"RC",{"$nulls":6},"both",null,null,113,113,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Strapping Low Back","PX-4903034","CDM",29799,"CPT",360,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt C/T 1 Lev","PX-4903053","CDM",64490,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt C/T 2 Lev","PX-4903054","CDM",64491,"CPT",360,"RC",{"$nulls":6},"both",null,null,1548.97,1548.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt C/T 3 Lev","PX-4903055","CDM",64492,"CPT",360,"RC",{"$nulls":6},"both",null,null,1443.02,1443.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt L/S 1 Lev","PX-4903056","CDM",64493,"CPT",360,"RC",{"$nulls":6},"both",null,null,2670.87,2670.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt L/S 2 Lev","PX-4903057","CDM",64494,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt L/S 3 Lev","PX-4903058","CDM",64495,"CPT",360,"RC",{"$nulls":6},"both",null,null,1387.32,1387.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Leishmania Antibody (Igg)","PX-LH300845","CDM",86717,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Opiate Conformation Urine","PX-LH300808","CDM",80361,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fentanyl & Norfentanl,Urine","PX-LH300809","CDM",80354,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Head/Neck/Ptrunk","PX-LH4400300","CDM",300,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Repair of Hernia V&a Lwr Abd","PX-LH4400832","CDM",832,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ag Class I (E,K)","PX-LH300810","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Uro Risk","PX-LH300811","CDM","LH300811","LOCAL",300,"RC",{"$nulls":6},"both",null,null,619,619,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping,Thorax","PX-4200016","CDM",29200,"CPT",761,"RC",{"$nulls":6},"both",null,null,93.09,93.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping,Elbow or Wrist","PX-4200017","CDM",29260,"CPT",450,"RC",{"$nulls":6},"both",null,null,83.64,83.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping,Hand or Finger","PX-4200018","CDM",29280,"CPT",360,"RC",{"$nulls":6},"both",null,null,85.38,85.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping,Hip","PX-4200019","CDM",29520,"CPT",761,"RC",{"$nulls":6},"both",null,null,100.95,100.95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping,Knee","PX-4200020","CDM",29530,"CPT",450,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping,Ankle or Foot","PX-4200021","CDM",29540,"CPT",450,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Colect W/Coloproctostomy","PX-4902528","CDM",44145,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Suture Sbd Dehiscence","PX-4902554","CDM",49900,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["C1 Esterase Inhibitor,Protein","PX-LH300847","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["C1 Inhibitor,Functional","PX-LH300846","CDM",86161,"CPT",300,"RC",{"$nulls":6},"both",null,null,36,36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Dexa Scan","PX-3200321","CDM",77081,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Neutrophil Function","PX-LH300815","CDM",82657,"CPT",300,"RC",{"$nulls":6},"both",null,null,66.51,66.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tpmt Activity","PX-LH300816","CDM",82657,"CPT",300,"RC",{"$nulls":6},"both",null,null,66.51,66.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Speech Sound Eval","PX-4440007","CDM",92523,"CPT",444,"RC",{"$nulls":6},"both",null,null,683.07,683.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Chemodenerv Musc Neck Dyston","PX-4902627","CDM",64616,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Chemodenerv 1 Extremity 1-4","PX-4902628","CDM",64642,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Injections Sclerosant for Spider Veins Lim/Trnk","PX-36468","CDM",36468,"CPT",982,"RC",{"$nulls":6},"both",null,null,330.78,330.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Esophagoscopy Flexible Transnasal Diagnostic","PX-43197","CDM",43197,"CPT",975,"RC",{"$nulls":6},"both",null,null,547.32,547.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},76.1,183.5,null,null,"facility"]
["Chemodenervation Muscle Neck Unilat for Dystonia","PX-64616","CDM",64616,"CPT",975,"RC",{"$nulls":6},"both",null,null,380.04,380.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},100.16,128.97,null,null,"facility"]
["Chemodenervation One Extremity 1-4 Muscle","PX-64642","CDM",64642,"CPT",975,"RC",{"$nulls":6},"both",null,null,429.54,429.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},99.11,144.95,null,null,"facility"]
["Chemodenervation 1 Extremity Ea Addl 1-4 Muscle","PX-64643","CDM",64643,"CPT",975,"RC",{"$nulls":6},"both",null,null,261.45,261.45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},64.64,88.22,null,null,"facility"]
["Helicobacter Pylori Stool","PX-LH300848","CDM",87338,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bls","PX-5420011","CDM","A0428","HCPCS",542,"RC",{"$nulls":6},"both",null,null,841.83,841.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Nuc Mebrofenin","PX-3430031","CDM","A9537","HCPCS",343,"RC",{"$nulls":6},"both",null,null,218,218,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Blood Admin 0-2 Hrs","PX-3910010","CDM",36430,"CPT",391,"RC",{"$nulls":6},"both",null,null,1311.54,1311.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Skin Pinch Graft","PX-4903123","CDM",15050,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coxsackie Antibody","PX-LH300817","CDM",86658,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.09,39.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair Umbilical Lesion","PX-4902649","CDM",49600,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Chemodenerv Musc Migraine","PX-4902655","CDM",64615,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cervical Collar (Universal)","PX-LH200510","CDM","lh200510","LOCAL",270,"RC",{"$nulls":6},"both",null,null,10.23,10.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Removal Impacted Cerumen Irrigation/Lvg Unilat","PX-69209","CDM",69209,"CPT",982,"RC",{"$nulls":6},"both",null,null,46.53,46.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},13.23,15.56,null,null,"facility"]
["Exc Lesion Tongue W/Clsr Anterior Two-Thirds","PX-41112","CDM",41112,"CPT",982,"RC",{"$nulls":6},"both",null,null,981.09,981.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},234.32,328.62,null,null,"facility"]
["Lh Norovirus Rna,Rt_Pcr Amp","PX-LH300819","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Drg Absc Cst Hmtma From Dentoalveolar Struxs","PX-41800","CDM",41800,"CPT",982,"RC",{"$nulls":6},"both",null,null,847.17,847.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},149.11,283.36,null,null,"facility"]
["Lh Tsi (Thyroid Stimulating Immunoglobulin)","PX-LH300820","CDM",84445,"CPT",300,"RC",{"$nulls":6},"both",null,null,413,413,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["X-Ray Exam Entire Spine 2/3 Vw","PX-3200340","CDM",72082,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["X-Ray Exam Hip Uni 1 Vw","PX-3200342","CDM",73501,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["X-Ray Exam Hip Uni 2-3 Vw","PX-3200343","CDM",73502,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["X-Ray Exam Femur 1 Vw","PX-3200345","CDM",73551,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["X-Ray Exam Femur 2/>","PX-3200346","CDM",73552,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC X-Ray Exam Hip Bil 2 Vw","PX-3200344","CDM",73521,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia,Surgery Intraperitoneal Upper Abdomen","PX-LH4400790","CDM",790,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tpmt Activity Mass Spectometry","PX-LH300822","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Calprotectin Stool","PX-LH300849","CDM",83993,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Leukemia/Lymphoma Evaluation 1st Marker","PX-LH300823","CDM",88184,"CPT",300,"RC",{"$nulls":6},"both",null,null,127,127,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture,Yeast/ID Excl Bld/Skn/Hr/Nl","PX-LH300824","CDM",87102,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.23,25.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mitochondria M2 Antibody Quantitative Nos","PX-LH300825","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr Exam Hip Bi 5/> Vw","PX-3200347","CDM",73523,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["X-Ray Exam Hip Bil 3-4 Vws","PX-3200348","CDM",73522,"CPT",320,"RC",{"$nulls":6},"both",null,null,496.75,496.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Anca Vasculitides","PX-LH300850","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Aldosterone/Renin Ratio Lc/Ms/Ms","PX-LH300851","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Visit to Determine Ldct Eligibility","PX-7700011","CDM","G0296","HCPCS",770,"RC",{"$nulls":6},"both",null,null,254.79,254.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ldct for Lung Cancer Screen","PX-3520015","CDM",71271,"CPT",352,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Calprotectin,Stool","PX-LH300852","CDM",83993,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Esophagoscopy Flexible Transoral Diagnostic","PX-43200","CDM",43200,"CPT",975,"RC",{"$nulls":6},"both",null,null,762.69,762.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},82.31,255.2,null,null,"facility"]
["Strongyloides Ab (Igg)","PX-LH300854","CDM",86682,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.03,39.03,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Pdgfra","PX-LH300855","CDM",81314,"CPT",300,"RC",{"$nulls":6},"both",null,null,988.53,988.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["T-Cell Receptor (Tcr) Beta Gene","PX-LH300856","CDM",81340,"CPT",300,"RC",{"$nulls":6},"both",null,null,626.76,626.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Oxycodone Conformation Gc/Ms Urine","PX-LH300828","CDM",80635,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Methadone Gc/Ms Urine","PX-LH300829","CDM",80358,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Barbiturate Gc/Ms Urine","PX-LH300835","CDM",80345,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Esophagogastroduodenoscopy Transoral Diagnostic","PX-43235","CDM",43235,"CPT",975,"RC",{"$nulls":6},"both",null,null,2812.68,2812.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},114.75,278.47,null,null,"facility"]
["Egd Transoral Biopsy Single/Multiple","PX-43239","CDM",43239,"CPT",975,"RC",{"$nulls":6},"both",null,null,1089.84,1089.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},129.51,364.61,null,null,"facility"]
["Tomo Digital Mammo Add-On","PX-4010008","CDM","G0279","HCPCS",401,"RC",{"$nulls":6},"both",null,null,129,129,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",975,"RC",{"$nulls":6},"both",null,null,654,654,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},220.52,220.52,null,null,"facility"]
["Egd Dilation Gastric/Duodenal Stricture","PX-43245","CDM",43245,"CPT",975,"RC",{"$nulls":6},"both",null,null,1713.96,1713.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},162.98,573.27,null,null,"facility"]
["Lh Microfilariae Detection","PX-LH300863","CDM",87210,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lyme Disease Nucl Acid Amp","PX-LH300861","CDM",87801,"CPT",300,"RC",{"$nulls":6},"both",null,null,210.6,210.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Malaria Ifa Screen","PX-LH300862","CDM",86750,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.57,39.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Egd Flexible Foreign Body Removal","PX-43247","CDM",43247,"CPT",975,"RC",{"$nulls":6},"both",null,null,1104.42,1104.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},164.6,369.9,null,null,"facility"]
["Lh Buprenophine,Quant,Urine","PX-LH300864","CDM",80348,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Egd Balloon Dilation Esophagus <30 Mm Diam","PX-43249","CDM",43249,"CPT",975,"RC",{"$nulls":6},"both",null,null,3126.72,3126.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},143.28,1043.75,null,null,"facility"]
["Egd Removal Tumor Polyp/Other Lesion Snare Tech","PX-43251","CDM",43251,"CPT",975,"RC",{"$nulls":6},"both",null,null,1427.37,1427.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},182.62,477.64,null,null,"facility"]
["Lh Igf Binding Protein-3","PX-LH300866","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Moblj Splenic Flxr Pfrmd Conjunct W/Prtl Colct","PX-44139","CDM",44139,"CPT",975,"RC",{"$nulls":6},"both",null,null,319.35,319.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},108.66,108.66,null,null,"facility"]
["Colectomy Partial W/Anastomosis","PX-44140","CDM",44140,"CPT",975,"RC",{"$nulls":6},"both",null,null,3622.2,3622.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},1231.05,1231.05,null,null,"facility"]
["Colectomy Prtl W/Coloproctostomy","PX-44145","CDM",44145,"CPT",975,"RC",{"$nulls":6},"both",null,null,4462.86,4462.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},1514.72,1514.72,null,null,"facility"]
["Lh Von Willebrand Factor Antigen","PX-LH300867","CDM",85246,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh West Nile Virus,Rna Amp","PX-LH300868","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Voriconazole Lc/Ms/Ms","PX-LH300869","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thyroid Cancer Marker Ab","PX-LH300872","CDM",86800,"CPT",300,"RC",{"$nulls":6},"both",null,null,126,126,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Collagen Type 1 C-Telopeptide (Ctx)","PX-LH300871","CDM",82523,"CPT",300,"RC",{"$nulls":6},"both",null,null,56.04,56.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Prealbumin","PX-LH300870","CDM",84134,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dhea Unconjugated","PX-LH300873","CDM",82626,"CPT",300,"RC",{"$nulls":6},"both",null,null,75.81,75.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thc/Ratio Urine","PX-LH300874","CDM",80349,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flu Vaccine Iiv4 Splt 0.5ml Im","PX-LH90688","CDM",90688,"CPT",636,"RC",{"$nulls":6},"both",null,null,62.61,62.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Glucose Monitor Report Reading","PX-5100060","CDM",95251,"CPT",942,"RC",{"$nulls":6},"both",null,null,98.76,98.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Benzodiazepines, Quantitative 1-12","PX-LH300875","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Proctosgmdsc Rgd Dx W/WO Collj Spec Br/Wa Spx","PX-45300","CDM",45300,"CPT",975,"RC",{"$nulls":6},"both",null,null,370.29,370.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},45.1,124.01,null,null,"facility"]
["HC Pt Eval","PX-4240010","CDM",97161,"CPT",420,"RC",{"$nulls":6},"both",null,null,293.25,293.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pt Eval","PX-4240011","CDM",97162,"CPT",420,"RC",{"$nulls":6},"both",null,null,293.25,293.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pt Eval","PX-4240012","CDM",97163,"CPT",420,"RC",{"$nulls":6},"both",null,null,293.25,293.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pt Re-Eval Est Plan of Care","PX-4240014","CDM",97164,"CPT",424,"RC",{"$nulls":6},"both",null,null,203.49,203.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ot Eval","PX-4340010","CDM",97165,"CPT",430,"RC",{"$nulls":6},"both",null,null,296.19,296.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ot Eval","PX-4340011","CDM",97166,"CPT",430,"RC",{"$nulls":6},"both",null,null,296.19,296.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ot Eval","PX-4340012","CDM",97167,"CPT",430,"RC",{"$nulls":6},"both",null,null,296.19,296.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ot Re-Eval Est Plan of Care","PX-4340014","CDM",97168,"CPT",430,"RC",{"$nulls":6},"both",null,null,204.48,204.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn","PX-62321","CDM",62321,"CPT",975,"RC",{"$nulls":6},"both",null,null,763.53,763.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},101.78,255.35,null,null,"facility"]
["Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn","PX-62323","CDM",62323,"CPT",975,"RC",{"$nulls":6},"both",null,null,751.35,751.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},94.08,251.25,null,null,"facility"]
["Colonoscopy Flx Dx W/Collj Spec When Pfrmd","PX-45378","CDM",45378,"CPT",975,"RC",{"$nulls":6},"both",null,null,2735.13,2735.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},171.81,327.02,null,null,"facility"]
["Colonoscopy W/Biopsy Single/Multiple","PX-45380","CDM",45380,"CPT",975,"RC",{"$nulls":6},"both",null,null,3537.24,3537.24,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},186.89,418.39,null,null,"facility"]
["Colsc Flx With Directed Submucosal Njx Any Sbst","PX-45381","CDM",45381,"CPT",975,"RC",{"$nulls":6},"both",null,null,1275.84,1275.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},186.56,427.23,null,null,"facility"]
["Colsc Flx W/Removal Lesion by Hot Bx Forceps","PX-45384","CDM",45384,"CPT",975,"RC",{"$nulls":6},"both",null,null,1398.51,1398.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},210.89,468.91,null,null,"facility"]
["Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq","PX-45385","CDM",45385,"CPT",975,"RC",{"$nulls":6},"both",null,null,3537.24,3537.24,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},236.4,436.46,null,null,"facility"]
["Colsc Flexible W/Transendoscopic Balloon Dilat","PX-45386","CDM",45386,"CPT",975,"RC",{"$nulls":6},"both",null,null,1758.69,1758.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},197.06,588.35,null,null,"facility"]
["Hemorrhoidectomy Xtrnl 2/> Column/Group","PX-46250","CDM",46250,"CPT",975,"RC",{"$nulls":6},"both",null,null,1365.75,1365.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},302.36,458.88,null,null,"facility"]
["Surg Tx Anal Fistula Subq","PX-46270","CDM",46270,"CPT",975,"RC",{"$nulls":6},"both",null,null,1522.05,1522.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},382.34,511.68,null,null,"facility"]
["Anoscopy Dx W/Collj Spec Br/Wa Spx When Prfrmd","PX-46600","CDM",46600,"CPT",975,"RC",{"$nulls":6},"both",null,null,342.27,342.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},39.18,114.49,null,null,"facility"]
["Lh Anti-Mullerian Hormone","PX-LH300877","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Strep Group B Antigen","PX-LH300876","CDM",86403,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.62,34.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ultrasound Exam Aaa Screen","PX-4020080","CDM",76706,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Laparoscopy Surg Cholecystectomy","PX-47562","CDM",47562,"CPT",975,"RC",{"$nulls":6},"both",null,null,1796.52,1796.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},610.51,610.51,null,null,"facility"]
["HC Njx Interlaminar Crv/Thrc W/Img","PX-4902880","CDM",62321,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Njx Interlaminar Lmbr/Sac W/Img","PX-4902881","CDM",62323,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Screen 1-7 Classes","PX-LH300878","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fecal Globin Immuno Scrn","PX-LH300879","CDM",82274,"CPT",300,"RC",{"$nulls":6},"both",null,null,47.76,47.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fecal Globin Immuno","PX-LH300880","CDM",82274,"CPT",300,"RC",{"$nulls":6},"both",null,null,47.76,47.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Brain W/O Dye","PX-6110020","CDM",70557,"CPT",611,"RC",{"$nulls":6},"both",null,null,1644.9,1644.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Brain W/Dye","PX-6110021","CDM",70558,"CPT",611,"RC",{"$nulls":6},"both",null,null,1127.18,1127.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Brain W/O & W/Dye","PX-6110022","CDM",70559,"CPT",611,"RC",{"$nulls":6},"both",null,null,3305.81,3305.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Stat Therapist Direct Time","PX-8675308","CDM",null,null,9999,"RC",{"$nulls":6},"both",null,null,225,225,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nicotine&Metabolites Lc/Ms","PX-LH800883","CDM",80323,"CPT",300,"RC",{"$nulls":6},"both",null,null,183,183,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Varicella-Zoster Virus Ab Acif","PX-LH300882","CDM",86787,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible","PX-49505","CDM",49505,"CPT",975,"RC",{"$nulls":6},"both",null,null,1432.02,1432.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},486.22,486.22,null,null,"facility"]
["Rpr Recrt Inguinal Hernia Any Age Reducible","PX-49520","CDM",49520,"CPT",975,"RC",{"$nulls":6},"both",null,null,1726.59,1726.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},586.71,586.71,null,null,"facility"]
["Lh Coccidioides Antibodies to Tp&F Antigens","PX-LH300884","CDM",86635,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.41,34.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Rpr Ingun Hernia Sliding Any Age","PX-49525","CDM",49525,"CPT",975,"RC",{"$nulls":6},"both",null,null,1567.38,1567.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},532.36,532.36,null,null,"facility"]
["Rpr Small Omphalocele W/Primary Closure","PX-49600","CDM",49600,"CPT",975,"RC",{"$nulls":6},"both",null,null,1999.11,1999.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},679.45,679.45,null,null,"facility"]
["Lh Vdrl Qual","PX-LH300885","CDM",86592,"CPT",300,"RC",{"$nulls":6},"both",null,null,192,192,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Laparoscopy Surg Rpr Initial Inguinal Hernia","PX-49650","CDM",49650,"CPT",975,"RC",{"$nulls":6},"both",null,null,1191.06,1191.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},404.14,404.14,null,null,"facility"]
["Laps Surg Rpr Recurrent Inguinal Hernia","PX-49651","CDM",49651,"CPT",975,"RC",{"$nulls":6},"both",null,null,1552.44,1552.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},526.89,526.89,null,null,"facility"]
["Lh Cyanide Blood","PX-LH300881","CDM",82600,"CPT",300,"RC",{"$nulls":6},"both",null,null,58.2,58.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh West Nile Virus Ab,Igm","PX-LH300886","CDM",86788,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.55,50.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis B Surface Ab","PX-LH300890","CDM",86317,"CPT",300,"RC",{"$nulls":6},"both",null,null,113,113,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis B Core Ab Igm","PX-LH300891","CDM",86705,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.31,35.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mrsa Screen","PX-LH300889","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Quantiferon TB Fold","PX-LH300892","CDM",86480,"CPT",300,"RC",{"$nulls":6},"both",null,null,504,504,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Blastomyces","PX-LH300887","CDM",86612,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.7,38.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Histoplasma","PX-LH300888","CDM",86698,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.37,41.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urinalysis Auto W/O Micro","PX-LH300893","CDM",81003,"CPT",300,"RC",{"$nulls":6},"both",null,null,19,19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sex Hormone Binding Globulin (Shgb)","PX-LH300894","CDM",84270,"CPT",300,"RC",{"$nulls":6},"both",null,null,171,171,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Olanzapine (Zypresa)","PX-LH300896","CDM",80342,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Insert Cath Pleura W/O Imaging","PX-4902906","CDM",32556,"CPT",450,"RC",{"$nulls":6},"both",null,null,5438.97,5438.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urine Pregnancy Test","PX-LH300895","CDM",81025,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.83,25.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urine Pregnancy Test by Visual Color","PX-LH300897","CDM",81025,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.83,25.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cystic Fibrosis Screen","PX-LH300898","CDM",81220,"CPT",300,"RC",{"$nulls":6},"both",null,null,1669.8,1669.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Levetiractam","PX-LH300899","CDM",80177,"CPT",300,"RC",{"$nulls":6},"both",null,null,153,153,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Estrogens Fractionated","PX-LH300900","CDM",82671,"CPT",300,"RC",{"$nulls":6},"both",null,null,227,227,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Xray Abdomen 1 View","PX-3200360","CDM",74018,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Xray Abdomen 2 Views","PX-3200361","CDM",74019,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Xray Abdomen 3+ Views","PX-3200362","CDM",74021,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Xray Chest 1 View","PX-3240020","CDM",71045,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Xray Chest 2 Views","PX-3240021","CDM",71046,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Xray Chest 4+ Views","PX-3240023","CDM",71048,"CPT",324,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cont Gluc Monitoring Patient Provided Equipment","PX-95249","CDM",95249,"CPT",521,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Mammo of Both Breasts","PX-4010016","CDM",77066,"CPT",401,"RC",{"$nulls":6},"both",null,null,689,689,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Mammo of One Breast","PX-4010015","CDM",77065,"CPT",401,"RC",{"$nulls":6},"both",null,null,540,540,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Mammo of Both Breasts","PX-4030015","CDM",77067,"CPT",403,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hbv Dna,Quant,Pcr","PX-LH300969","CDM",87517,"CPT",300,"RC",{"$nulls":6},"both",null,null,341,341,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebv Dna, Quant Pcr","PX-LH300970","CDM",87799,"CPT",300,"RC",{"$nulls":6},"both",null,null,171.36,171.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cont Gluc Mntr Pt Prov Eqp","PX-5100062","CDM",95249,"CPT",920,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Lower Intestinal Endoscopic Procedure","PX-LH4400811","CDM",811,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Screening Colonoscopy Procedure","PX-LH4400812","CDM",812,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Combined Upper & Lower Gastrointestinal Procedure","PX-LH4400813","CDM",813,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Urine,Colony Count","PX-LH300971","CDM",87086,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Sesnitivity Enzyme","PX-LH300972","CDM",87185,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Typing,Immunologic","PX-LH300973","CDM",87147,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ana Titer Pattern Ref","PX-LH300974","CDM",86039,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Salm/Shig Culture Ref","PX-LH300975","CDM",87045,"CPT",300,"RC",{"$nulls":6},"both",null,null,75,75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Campy Culture","PX-LH300976","CDM",87046,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Shrga Toxins Ecoli","PX-LH300977","CDM",87427,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anaerobic Culture ID","PX-LH300978","CDM",87076,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Def ID,Fungal Mold","PX-LH300980","CDM",87107,"CPT",300,"RC",{"$nulls":6},"both",null,null,30.96,30.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh O&P Smear,Complex Stain","PX-LH300979","CDM",87209,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fish Bcr/Abl IP Situ 100-200 Cells Ref","PX-LH300981","CDM",88275,"CPT",300,"RC",{"$nulls":6},"both",null,null,153.57,153.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C.Diff-Ia","PX-LH300967","CDM",87449,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C.Diff-Toxins","PX-LH300968","CDM",87324,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pregnenolone","PX-LH300982","CDM",84140,"CPT",300,"RC",{"$nulls":6},"both",null,null,62.01,62.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Endoscopy Swallow Test","PX-4400030","CDM",92612,"CPT",440,"RC",{"$nulls":6},"both",null,null,581.82,581.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Infliximab Level","PX-LH300983","CDM",80230,"CPT",300,"RC",{"$nulls":6},"both",null,null,115.71,115.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thyroglobulin,Immuno","PX-LH300984","CDM",84432,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.18,48.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antibody Titer","PX-LH300985","CDM",86886,"CPT",300,"RC",{"$nulls":6},"both",null,null,15.54,15.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pyruvic Acid","PX-LH300989","CDM",84210,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.44,43.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Amino Acid Analysis,Plasma 6/> Quant Ea Specmn","PX-LH300992","CDM",82139,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.61,50.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fragile X Alleles","PX-LH300986","CDM",82144,"CPT",300,"RC",{"$nulls":6},"both",null,null,134.67,134.67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Amino Acid Analysis 2 to 5 Quant Ea Specmn","PX-LH300988","CDM",82136,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Organic Acids Qual,Urine","PX-LH300991","CDM",83919,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.35,49.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acylcarnitine Quant Ea Spec","PX-LH300990","CDM",82017,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.61,50.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chromosomal Microarray","PX-LH300987","CDM",81229,"CPT",300,"RC",{"$nulls":6},"both",null,null,3480,3480,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Screen 10 - Non-Medicare","PX-LH300993","CDM",80306,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.42,51.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hydromorphone","PX-LH300994","CDM",80361,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Oncoheme Ngs","PX-LH300995","CDM",81450,"CPT",300,"RC",{"$nulls":6},"both",null,null,2278.59,2278.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti-Drug Ab","PX-LH300996","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Adalimumab Level","PX-LH300997","CDM",80145,"CPT",300,"RC",{"$nulls":6},"both",null,null,115.71,115.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antiphospholipid Antibodies (Igg & Igm)","PX-LH300999","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Phosphatidylserine Antibodies (Igg,Iga,Igm)","PX-LH300998","CDM",86148,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.21,48.21,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fungal Smear Fluores/Af Stain","PX-LH301001","CDM",87206,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.17,16.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Fungal (Excl Bld/Skin,Hair,Nail)","PX-LH301000","CDM",87102,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.23,25.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Jak2 V617f Qualitative","PX-LH301002","CDM",81270,"CPT",300,"RC",{"$nulls":6},"both",null,null,458,458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hantavirus Antibody Igg","PX-LH301004","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hantavirus Antibody Igm","PX-LH301005","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Kleihauer-Betke Stain","PX-LH301006","CDM",85460,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.19,23.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh General Health Panel","PX-LH301011","CDM",80050,"CPT",300,"RC",{"$nulls":6},"both",null,null,359.09,359.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tangential Bx Sngl Skin Lesion","PX-4903277","CDM",11102,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tangential Bx Addl Skin Lesion","PX-4903278","CDM",11103,"CPT",761,"RC",{"$nulls":6},"both",null,null,286.59,286.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Punch Bx Sngl Skin Lesion","PX-4903279","CDM",11104,"CPT",761,"RC",{"$nulls":6},"both",null,null,1118.76,1118.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Punch Bx Addl Skin Lesion","PX-4903280","CDM",11105,"CPT",761,"RC",{"$nulls":6},"both",null,null,328.1,328.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Incisional Bx Sngl Skin Lesion","PX-4903281","CDM",11106,"CPT",761,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Incisional Bx Addl Skin Lesion","PX-4903282","CDM",11107,"CPT",761,"RC",{"$nulls":6},"both",null,null,450.84,450.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Tangential Biopsy Skin Single Lesion","PX-11102","CDM",11102,"CPT",982,"RC",{"$nulls":6},"both",null,null,292.41,292.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},35.57,97.78,null,null,"facility"]
["Tangential Biopsy Skin Ea Sep/Additional Lesion","PX-11103","CDM",11103,"CPT",982,"RC",{"$nulls":6},"both",null,null,145.89,145.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},20.65,48.81,null,null,"facility"]
["Punch Biopsy Skin Single Lesion","PX-11104","CDM",11104,"CPT",982,"RC",{"$nulls":6},"both",null,null,363.27,363.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},43.93,121.54,null,null,"facility"]
["Punch Biopsy Skin Ea Sep/Additional Lesion","PX-11105","CDM",11105,"CPT",982,"RC",{"$nulls":6},"both",null,null,172.2,172.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},23.94,57.66,null,null,"facility"]
["Incisional Biopsy Skin Single Lesion","PX-11106","CDM",11106,"CPT",982,"RC",{"$nulls":6},"both",null,null,450.84,450.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.95,150.86,null,null,"facility"]
["Incisional Biopsy Skin Ea Sep/Additional Lesion","PX-11107","CDM",11107,"CPT",982,"RC",{"$nulls":6},"both",null,null,205.98,205.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},28.69,68.97,null,null,"facility"]
["Perq Replacement Gtube Not Req Revj Gstrst Trc","PX-43762","CDM",43762,"CPT",975,"RC",{"$nulls":6},"both",null,null,655.56,655.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},34.13,219.14,null,null,"facility"]
["Perq Replacement Gtube Req Revj Gstrst Trc","PX-43763","CDM",43763,"CPT",975,"RC",{"$nulls":6},"both",null,null,965.94,965.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},81.19,323.17,null,null,"facility"]
["Lh Sickle Cell Screen","PX-LH301007","CDM",85660,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.53,16.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Occult Blood Immuno-Medicare Screen","PX-LH301008","CDM","G0328","HCPCS",300,"RC",{"$nulls":6},"both",null,null,54.15,54.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Occult Blood Fecal Globin Immuno","PX-LH301009","CDM",82274,"CPT",300,"RC",{"$nulls":6},"both",null,null,47.76,47.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Concentration for Infectious Agents","PX-LH301010","CDM",87015,"CPT",300,"RC",{"$nulls":6},"both",null,null,20.04,20.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Diagnostic Lumbar Spinal Puncture","PX-62270","CDM",62270,"CPT",975,"RC",{"$nulls":6},"both",null,null,414.84,414.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},57.94,139.48,null,null,"facility"]
["Therapeutic Spinal Puncture Drainage CSF","PX-62272","CDM",62272,"CPT",975,"RC",{"$nulls":6},"both",null,null,518.25,518.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},82.77,174.78,null,null,"facility"]
["Lh Cuture Def ID,Fungal,Yeast","PX-LH301013","CDM",87106,"CPT",300,"RC",{"$nulls":6},"both",null,null,30.96,30.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture,Mycobacterium (Afb)","PX-LH301012","CDM",87116,"CPT",300,"RC",{"$nulls":6},"both",null,null,32.4,32.4,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Trigeminal Nerve Each Branch","PX-64400","CDM",64400,"CPT",975,"RC",{"$nulls":6},"both",null,null,323.22,323.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},47.43,108.66,null,null,"facility"]
["Injection Aa&/Strd Greater Occipital Nerve","PX-64405","CDM",64405,"CPT",975,"RC",{"$nulls":6},"both",null,null,119.64,119.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},48.26,70.85,null,null,"facility"]
["Injection Aa&/Strd Axillary Nerve W/Img Gdn","PX-64417","CDM",64417,"CPT",975,"RC",{"$nulls":6},"both",null,null,464.61,464.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},60.16,155.44,null,null,"facility"]
["Injection Aa&/Strd Suprascapular Nerve","PX-64418","CDM",64418,"CPT",975,"RC",{"$nulls":6},"both",null,null,247.14,247.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.13,82.91,null,null,"facility"]
["Injection Aa&/Strd Intercostal Nrv Single Lvl","PX-64420","CDM",64420,"CPT",975,"RC",{"$nulls":6},"both",null,null,282.72,282.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.07,94.69,null,null,"facility"]
["Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl","PX-64421","CDM",64421,"CPT",975,"RC",{"$nulls":6},"both",null,null,95.19,95.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},23.44,31.95,null,null,"facility"]
["Injection Aa&/Strd Pudendal Nerve","PX-64430","CDM",64430,"CPT",975,"RC",{"$nulls":6},"both",null,null,282.51,282.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},51.48,94.7,null,null,"facility"]
["Injection Aa&/Strd Sciatic Nerve W/Img Gdn","PX-64445","CDM",64445,"CPT",975,"RC",{"$nulls":6},"both",null,null,467.58,467.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},67.86,153.65,null,null,"facility"]
["Injection Aa&/Strd Other Peripheral Nerve/Branch","PX-64450","CDM",64450,"CPT",975,"RC",{"$nulls":6},"both",null,null,216.54,216.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},39.51,72.58,null,null,"facility"]
["Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level","PX-64483","CDM",64483,"CPT",975,"RC",{"$nulls":6},"both",null,null,715.98,715.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},105.86,239.46,null,null,"facility"]
["Njx Aa&/Strd Tfrml Epi Lumbar/Sacral Ea Addl","PX-64484","CDM",64484,"CPT",975,"RC",{"$nulls":6},"both",null,null,322.02,322.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},48.52,107.78,null,null,"facility"]
["Injection Anes Agent Sphenopalatine Ganglion","PX-64505","CDM",64505,"CPT",975,"RC",{"$nulls":6},"both",null,null,406.8,406.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},97.95,137.24,null,null,"facility"]
["Njx Anes Stellate Ganglion Crv Sympathetic","PX-64510","CDM",64510,"CPT",975,"RC",{"$nulls":6},"both",null,null,424.95,424.95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},73.41,142.18,null,null,"facility"]
["Injection Anes Superior Hypogastric Plexus","PX-64517","CDM",64517,"CPT",975,"RC",{"$nulls":6},"both",null,null,562.14,562.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},120.11,188.22,null,null,"facility"]
["Injection Anes Lmbr/Thrc Paravertbrl Sympathetic","PX-64520","CDM",64520,"CPT",975,"RC",{"$nulls":6},"both",null,null,671.88,671.88,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},81.11,224.53,null,null,"facility"]
["Injx Anes Celiac Plexus W/WO Radiologic Monitrng","PX-64530","CDM",64530,"CPT",975,"RC",{"$nulls":6},"both",null,null,664.77,664.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},89.97,222.25,null,null,"facility"]
["Chemodnrvtj Musc Musc Innervated Facial Nrv Unil","PX-64612","CDM",64612,"CPT",975,"RC",{"$nulls":6},"both",null,null,390.45,390.45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},113.13,131.47,null,null,"facility"]
["Lh Candida Species,Direct Probe","PX-LH301014","CDM",87480,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gardnerella Vaginalis,Direct Probe","PX-LH301015","CDM",87510,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Trichomonas Vaginalis,Direct Probe","PX-LH301016","CDM",87660,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Dstrj Neurolytic Agent Other Peripheral Nerve","PX-64640","CDM",64640,"CPT",975,"RC",{"$nulls":6},"both",null,null,720.06,720.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},113.25,240.95,null,null,"facility"]
["Lh Adenovirus Antigen,Eia","PX-LH301022","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Norovirus,Eia,Stool","PX-LH301023","CDM",87449,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis Be Ag","PX-LH301018","CDM",87350,"CPT",300,"RC",{"$nulls":6},"both",null,null,89,89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis Be Ab","PX-LH301019","CDM",86707,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcv Quant Rt Pcr","PX-LH301020","CDM",87522,"CPT",300,"RC",{"$nulls":6},"both",null,null,332,332,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Escherichia Coli 0157 Culture","PX-LH301021","CDM",87046,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Removal FB Eye Conjunctival Superficial","PX-65205","CDM",65205,"CPT",982,"RC",{"$nulls":6},"both",null,null,81.99,81.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},27.36,27.69,null,null,"facility"]
["Rmvl FB Xtrnl Eye Corneal W/O Slit Lamp","PX-65220","CDM",65220,"CPT",982,"RC",{"$nulls":6},"both",null,null,173.31,173.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},38.85,58.17,null,null,"facility"]
["Lh Infliximab Anti Drug Antibody","PX-LH301024","CDM",null,null,300,"RC",{"$nulls":6},"both",null,null,138,138,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture ID by Dna Sequencing","PX-LH301025","CDM",87153,"CPT",300,"RC",{"$nulls":6},"both",null,null,346.08,346.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Neutralization Test,Viral","PX-LH301026","CDM",86382,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.73,50.73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Whey,Ige","PX-LH301027","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Casein,Ige","PX-LH301028","CDM",86008,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.79,53.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp","PX-66984","CDM",66984,"CPT",982,"RC",{"$nulls":6},"both",null,null,1552.08,1552.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},519.79,519.79,null,null,"facility"]
["Lh Procalcitonin","PX-LH301031","CDM",84145,"CPT",300,"RC",{"$nulls":6},"both",null,null,204,204,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor Binding Antibody","PX-LH301033","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor Modulating Antibody","PX-LH301034","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor Blocking Antibody","PX-LH301035","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Posaconazole","PX-LH301032","CDM",80187,"CPT",300,"RC",{"$nulls":6},"both",null,null,81.33,81.33,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Susceptibility Disk Method per Plate 12/<","PX-LH301036","CDM",87184,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Test Pres,Chem Analyzer","PX-LH301037","CDM",80307,"CPT",300,"RC",{"$nulls":6},"both",null,null,186.42,186.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Skeletal Muscle Relaxant 1-2","PX-LH301038","CDM",80369,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Test Nos","PX-LH301039","CDM",80375,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh H Pylori,Urea Breath Test","PX-LH301040","CDM",83013,"CPT",300,"RC",{"$nulls":6},"both",null,null,508,508,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inject Aa&/Strd Nerves Nrvtg Si Joint W/Img","PX-4903350","CDM",64451,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inject Aa&/Strd Genicular Nrv Branches W/Img","PX-4903351","CDM",64454,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destruct Neurolytic Agt Genicular Nrv W/Img","PX-4903352","CDM",64624,"CPT",360,"RC",{"$nulls":6},"both",null,null,5858.31,5858.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Msh2 Gene Full Seq","PX-LH301041","CDM",81295,"CPT",300,"RC",{"$nulls":6},"both",null,null,1145.1,1145.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Msh2 Gene Dup.Delete Variant","PX-LH301042","CDM",81297,"CPT",300,"RC",{"$nulls":6},"both",null,null,639.9,639.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mlh1 Gene Full Seq","PX-LH301043","CDM",81292,"CPT",300,"RC",{"$nulls":6},"both",null,null,2026.2,2026.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mlh1 Gene Dup/Delete Variant","PX-LH301044","CDM",81294,"CPT",300,"RC",{"$nulls":6},"both",null,null,607.2,607.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Msh6 Gene Full Seq","PX-LH301045","CDM",81298,"CPT",300,"RC",{"$nulls":6},"both",null,null,1925.55,1925.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Msh6 Gene Dup/Delete Variant","PX-LH301046","CDM",81300,"CPT",300,"RC",{"$nulls":6},"both",null,null,714,714,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pms2 Gene Full Seq","PX-LH301047","CDM",81317,"CPT",300,"RC",{"$nulls":6},"both",null,null,2029.5,2029.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pms2 Gene Dup/Delete Variant","PX-LH301048","CDM",81319,"CPT",300,"RC",{"$nulls":6},"both",null,null,610.5,610.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mopath Procedure Level 4","PX-LH301049","CDM",81403,"CPT",300,"RC",{"$nulls":6},"both",null,null,555.6,555.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Yersina Culture","PX-LH301050","CDM",87046,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Diagnostic Lumbar Spinal Puncture W/Fluor or CT","PX-62328","CDM",62328,"CPT",975,"RC",{"$nulls":6},"both",null,null,641.94,641.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},79.83,214.73,null,null,"facility"]
["Therapeutic Spinal Pnxr Drainage CSF W/Fluor/CT","PX-62329","CDM",62329,"CPT",975,"RC",{"$nulls":6},"both",null,null,750.96,750.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},96.43,251.64,null,null,"facility"]
["Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img","PX-64451","CDM",64451,"CPT",975,"RC",{"$nulls":6},"both",null,null,663.42,663.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},77.35,221.76,null,null,"facility"]
["Injection Aa&/Strd Genicular Nrv Branches W/Img","PX-64454","CDM",64454,"CPT",975,"RC",{"$nulls":6},"both",null,null,645.72,645.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},78.01,215.86,null,null,"facility"]
["Destruction Neurolytic Agt Genicular Nerve W/Img","PX-64624","CDM",64624,"CPT",975,"RC",{"$nulls":6},"both",null,null,1131.42,1131.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},139.13,378.16,null,null,"facility"]
["Drainage External Ear Abscess/Hematoma Simple","PX-69000","CDM",69000,"CPT",982,"RC",{"$nulls":6},"both",null,null,538.11,538.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},120.79,180.38,null,null,"facility"]
["Rmvl FB Xtrnl Auditory Canal W/O Anes","PX-69200","CDM",69200,"CPT",982,"RC",{"$nulls":6},"both",null,null,231.06,231.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},44.76,77.5,null,null,"facility"]
["Removal Impacted Cerumen Instrumentation Unilat","PX-69210","CDM",69210,"CPT",982,"RC",{"$nulls":6},"both",null,null,136.59,136.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},30.5,45.89,null,null,"facility"]
["HC Dx Lumbar Signal Pnxr W/Fluor/CT","PX-4903356","CDM",62328,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Therapeutic Spinal Pnxr CSF Fluor/CT","PX-4903357","CDM",62329,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lrbc,Irradiated Ea Unit","PX-LH301051","CDM","P9040","CPT",390,"RC",{"$nulls":6},"both",null,null,757.44,757.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Evicore","PX-3201001","CDM","G1001","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Medcurrent","PX-3201002","CDM","G1002","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Medicalis","PX-3201003","CDM","G1003","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Ndsc","PX-3201004","CDM","G1004","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Aim","PX-3201007","CDM","G1007","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Cranberry Pk","PX-3201008","CDM","G1008","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Stanson","PX-3201010","CDM","G1010","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Qualified Nos","PX-3201011","CDM","G1011","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Needle Insert W/O Inj 1 or 2 Musc","PX-4903367","CDM",20560,"CPT",420,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Needle Insert W/O Inj 3+ Musc","PX-4903368","CDM",20561,"CPT",420,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ehrlichia Chaffeensis","PX-LH301052","CDM",86666,"CPT",300,"RC",{"$nulls":6},"both",null,null,79,79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Trichomonas Vaginalis Rna, Amp Qual","PX-LH301053","CDM",87661,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hla A29 Birdshot Retinochoroidopathy","PX-LH301054","CDM",81374,"CPT",300,"RC",{"$nulls":6},"both",null,null,222.99,222.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Arsenic","PX-LH301055","CDM",82175,"CPT",300,"RC",{"$nulls":6},"both",null,null,149,149,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Guidance Needle Placement Img S&I","PX-76942","CDM",76942,"CPT",972,"RC",{"$nulls":6},"both",null,null,2360.13,2360.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},27.67,56.34,null,null,"facility"]
["Lh P190 Bcr-Abl1","PX-LH301057","CDM",81207,"CPT",300,"RC",{"$nulls":6},"both",null,null,1048,1048,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh P210 Bcr-Abl1","PX-LH301058","CDM",81206,"CPT",300,"RC",{"$nulls":6},"both",null,null,1186,1186,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Nonmd Online Assmt 5-10 Min","PX-4200200","CDM","G2061","HCPCS",420,"RC",{"$nulls":6},"both",null,null,38.01,38.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Nonmd Online Assmt 21> Min","PX-4200202","CDM","G2063","HCPCS",420,"RC",{"$nulls":6},"both",null,null,101.76,101.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sars-Cov-2 Covid-19 Amp Prb","PX-LH301059","CDM",87635,"CPT",300,"RC",{"$nulls":6},"both",null,null,153.93,153.93,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Trab","PX-LH301061","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vit D 25-Oh,Total","PX-LH301060","CDM",82306,"CPT",300,"RC",{"$nulls":6},"both",null,null,228,228,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Zonisamide","PX-LH301062","CDM",80203,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.75,39.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergen Specific Ige,Each","PX-LH301063","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aspergillus Fumigatus (M3) Igg","PX-LH301065","CDM",86001,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aspergillus Antigen,Eia,Serum","PX-LH301064","CDM",87305,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bile Acids,Total","PX-LH301066","CDM",82239,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.36,51.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Activated Protein C Resistance","PX-LH301067","CDM",85307,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.96,45.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tricyclic & Cyclicals 6 or More","PX-LH301068","CDM",80337,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antidepressant Not Specified","PX-LH301069","CDM",80338,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antidepressants Class 1 or 2","PX-LH301070","CDM",80332,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coronavirus (Covid-19) Antibody,Igg","PX-LH301071","CDM",86769,"CPT",300,"RC",{"$nulls":6},"both",null,null,74,74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Igg Subclass","PX-LH301072","CDM",82787,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.06,24.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis a Ab, Total","PX-LH301073","CDM",86708,"CPT",300,"RC",{"$nulls":6},"both",null,null,98,98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coronavirus (Covid-19) Antigen","PX-LH301074","CDM",87426,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.99,105.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pregablin,Urine,Quant","PX-LH301075","CDM",80366,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pregablin,Urine,Quant,Medicare","PX-LH301076","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,430.29,430.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Screen,Urine,Pp Dir Obs","PX-LH301077","CDM",80305,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcv Screen High Risk Indiv and Other Covered Indicat","PX-LH301078","CDM","G0472","HCPCS",300,"RC",{"$nulls":6},"both",null,null,139.05,139.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Selenium, Blood","PX-LH301079","CDM",84255,"CPT",300,"RC",{"$nulls":6},"both",null,null,76.59,76.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Soluble Transferrin Receptor","PX-LH301080","CDM",84238,"CPT",300,"RC",{"$nulls":6},"both",null,null,109.71,109.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Amylase Isoenzyme","PX-LH301081","CDM",82150,"CPT",300,"RC",{"$nulls":6},"both",null,null,51,51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lyme Disease Antibodies Confirm,Each","PX-LH301082","CDM",86617,"CPT",300,"RC",{"$nulls":6},"both",null,null,119,119,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lysozyme (Rk208) Ige","PX-LH301083","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sm Muscle Ab Titer","PX-LH301084","CDM",86256,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.15,36.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hbv Screen Non-Preg High Risk Indiv Medicare","PX-LH301085","CDM","G0499","HCPCS",300,"RC",{"$nulls":6},"both",null,null,84.81,84.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ext Ecg >48hr<7d Recording","PX-7310013","CDM",93242,"CPT",761,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ext Ecg >7d<15d Recording","PX-7310017","CDM",93246,"CPT",360,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mycophenolic Acid","PX-LH301086","CDM",80180,"CPT",300,"RC",{"$nulls":6},"both",null,null,123,123,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["External Ecg Rec>7d<15d Recording","PX-93246","CDM",93246,"CPT",985,"RC",{"$nulls":6},"both",null,null,34.77,34.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},11.63,11.63,null,null,"facility"]
["Assay of Alcohol (Ethanol) Breath","PX-82075","CDM",82075,"CPT",971,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pancreatic Elastase-1","PX-LH301087","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Upper Gastro Endoscopic Procedure","PX-LH4400731","CDM",731,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rheumatoid Factor,Each","PX-LH301088","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cryptococcal Ag","PX-LH301090","CDM",86403,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.62,34.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hiv-1 Rna Quant Pcr","PX-LH301089","CDM",87536,"CPT",300,"RC",{"$nulls":6},"both",null,null,691,691,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia","PX-LH00370","CDM",null,null,370,"RC",{"$nulls":6},"both",null,null,681,681,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Serum","PX-LH301091","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Serum (Medicare)","PX-LH301092","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Urine","PX-LH301093","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, (Medicare)","PX-LH301094","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Arterial Puncture","PX-LH301095","CDM",36600,"CPT",300,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bile Acids,Pregnancy","PX-LH301097","CDM",82542,"CPT",300,"RC",{"$nulls":6},"both",null,null,72.27,72.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cytopath Cerv/Vag Thin Layer","PX-LH88142","CDM",88142,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cytopath C/V Thin Layer Redo","PX-LH88143","CDM",88143,"CPT",300,"RC",{"$nulls":6},"both",null,null,69.12,69.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Skin Test Tuberculosis Intradermal","PX-86580","CDM",86580,"CPT",971,"RC",{"$nulls":6},"both",null,null,37.98,37.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},9.99,9.99,null,null,"facility"]
["Lh Lab Handling Fee","PX-LH99000","CDM",99000,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen","PX-88142","CDM",88142,"CPT",971,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},20.26,20.26,null,null,"facility"]
["Debridement Open Wound First 20 Sq Cm/<","PX-97597","CDM",97597,"CPT",982,"RC",{"$nulls":6},"both",null,null,294,294,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},33.43,98.27,null,null,"facility"]
["Im Adm Prq ID Subq/Im Njxs 1 Vaccine","PX-90471","CDM",90471,"CPT",982,"RC",{"$nulls":6},"both",null,null,60.3,60.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},20.14,20.14,null,null,"facility"]
["Lh Urinalysis by Dipstick or Tablet Reagent W/O Micro","PX-LH81002","CDM",81002,"CPT",300,"RC",{"$nulls":6},"both",null,null,10.44,10.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cardiopulmonary Resuscitation","PX-92950","CDM",92950,"CPT",982,"RC",{"$nulls":6},"both",null,null,929.55,929.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},170.82,311.62,null,null,"facility"]
["Cardioversion Elective Arrhythmia External","PX-92960","CDM",92960,"CPT",982,"RC",{"$nulls":6},"both",null,null,441.78,441.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},101.75,147.92,null,null,"facility"]
["Ecg Routine Ecg W/Least 12 Lds W/I&R","PX-93000","CDM",93000,"CPT",985,"RC",{"$nulls":6},"both",null,null,41.04,41.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},13.76,13.76,null,null,"facility"]
["Ecg Routine Ecg W/Least 12 Lds Trcg Only W/O I&R","PX-93005","CDM",93005,"CPT",521,"RC",{"$nulls":6},"both",null,null,18.06,18.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ecg Routine Ecg W/Least 12 Lds I&R Only","PX-93010","CDM",93010,"CPT",985,"RC",{"$nulls":6},"both",null,null,22.98,22.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},6.55,7.7,null,null,"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg W/Si&R","PX-93015","CDM",93015,"CPT",985,"RC",{"$nulls":6},"both",null,null,209.76,209.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},70.09,70.09,null,null,"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg W/O I&R","PX-93016","CDM",93016,"CPT",985,"RC",{"$nulls":6},"both",null,null,60.3,60.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},20.14,20.14,null,null,"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only","PX-93017","CDM",93017,"CPT",985,"RC",{"$nulls":6},"both",null,null,109.8,109.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},36.68,36.68,null,null,"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg I&R Only","PX-93018","CDM",93018,"CPT",985,"RC",{"$nulls":6},"both",null,null,39.66,39.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},13.27,13.27,null,null,"facility"]
["Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj","PX-94010","CDM",94010,"CPT",982,"RC",{"$nulls":6},"both",null,null,79.35,79.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},7.7,26.53,null,null,"facility"]
["Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn","PX-94060","CDM",94060,"CPT",982,"RC",{"$nulls":6},"both",null,null,113.73,113.73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},9.67,37.99,null,null,"facility"]
["Vital Capacity Total Separate Procedure","PX-94150","CDM",94150,"CPT",982,"RC",{"$nulls":6},"both",null,null,74.66,74.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Pressurized/Nonpressurized Inhalation Treatment","PX-94640","CDM",94640,"CPT",982,"RC",{"$nulls":6},"both",null,null,22.98,22.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},7.7,7.7,null,null,"facility"]
["Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx","PX-95115","CDM",95115,"CPT",982,"RC",{"$nulls":6},"both",null,null,29.85,29.85,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},9.99,9.99,null,null,"facility"]
["Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs Njxs","PX-95117","CDM",95117,"CPT",982,"RC",{"$nulls":6},"both",null,null,35.73,35.73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},11.96,11.96,null,null,"facility"]
["Lh Screening Cytopathology, Cervical or Vaginal","PX-LHG0123","CDM","G0123","CPT",923,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Infectious Disease (Viral Respiratory Tract Infection), Pathogen-Specific Rna, 4 Targets","PX-LH0241U","CDM","0241U","CPT",310,"RC",{"$nulls":6},"both",null,null,427.89,427.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Hemoglobin, Glycosylated A1c","PX-LH83037","CDM",83037,"CPT",300,"RC",{"$nulls":6},"both",null,null,76,76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Kappa/Lambda Light Chains, Free With Ratio","PX-LH83521","CDM",83521,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Therapeutic Drug Assays","PX-LH80181","CDM",80181,"CPT",300,"RC",{"$nulls":6},"both",null,null,55.92,55.92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cryptosporidium Ag Ia","PX-LH87328","CDM",87328,"CPT",306,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flow Cytometry Technique for Dna or Cell Analysis, Each Additional Marker","PX-LH88185","CDM",88185,"CPT",300,"RC",{"$nulls":6},"both",null,null,179,179,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chg Drug Assay Vedolizumab","PX-LH80280","CDM",80280,"CPT",300,"RC",{"$nulls":6},"both",null,null,115.71,115.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Infectious Agent Detection by Nucleic Acid","PX-LH87624","CDM",87624,"CPT",300,"RC",{"$nulls":6},"both",null,null,267,267,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Susceptbilty Stdy Antimicrbial Agnt Agar Dilutj","PX-LH87181","CDM",87181,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cell Count Miscellaneous Body Fluids","PX-LH89050","CDM",89050,"CPT",300,"RC",{"$nulls":6},"both",null,null,14.16,14.16,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Iadna Streptococcus Group B Amplified Probe Tq","PX-LH87653","CDM",87653,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Iadna S Aureus Methicillin Resist Amp Probe Tq","PX-LH87641","CDM",87641,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Helicobacter Pylori; Drug Administration","PX-LH83014","CDM",83014,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.58,23.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Iaadiadoo Not Otherwise Specified","PX-LH87899","CDM",87899,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Basic Metabolic Panel Calcium Ionized","PX-LH80047","CDM",80047,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.19,41.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Blood Count; Hematocrit (Hct)","PX-LH85014","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Respiratory Syncytial Virus","PX-LH87634","CDM",87634,"CPT",300,"RC",{"$nulls":6},"both",null,null,210.6,210.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza a/B by Pcr","PX-LH87502","CDM",87502,"CPT",300,"RC",{"$nulls":6},"both",null,null,287.4,287.4,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Group a Strep by Pcr","PX-LH87651","CDM",87651,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influeza a/B, Sars, Cov2, Rsv by Pcr","PX-LH87631","CDM",87631,"CPT",300,"RC",{"$nulls":6},"both",null,null,977,977,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess","PX-97602","CDM",97602,"CPT",982,"RC",{"$nulls":6},"both",null,null,126.12,126.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Anesthesia Extreme Age Patient<1 Yr&>70","PX-99100","CDM",99100,"CPT",{"$nulls":8},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min","PX-99234","CDM",99234,"CPT",982,"RC",{"$nulls":6},"both",null,null,274.56,274.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},92.27,92.27,null,null,"facility"]
["Hospital IP/Obs Care Same Date Mod Mdm 70 Min","PX-99235","CDM",99235,"CPT",982,"RC",{"$nulls":6},"both",null,null,450.06,450.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},151.08,151.08,null,null,"facility"]
["Hospital IP/Obs Care Same Date High Mdm 85 Min","PX-99236","CDM",99236,"CPT",982,"RC",{"$nulls":6},"both",null,null,587.64,587.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},197.3,197.3,null,null,"facility"]
["Hospital IP/Obs Discharge Day Mgmt 30 Min/<","PX-99238","CDM",99238,"CPT",982,"RC",{"$nulls":6},"both",null,null,230.07,230.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},77.17,77.17,null,null,"facility"]
["Hospital IP/Obs Discharge Day Mgmt > 30 Min","PX-99239","CDM",99239,"CPT",982,"RC",{"$nulls":6},"both",null,null,324.87,324.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},108.96,108.96,null,null,"facility"]
["Emergency Department Visit May Not Req Phys/Qhp","PX-99281","CDM",99281,"CPT",981,"RC",{"$nulls":6},"both",null,null,31.59,31.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},10.66,10.66,null,null,"facility"]
["Emergency Department Visit Straightforward Mdm","PX-99282","CDM",99282,"CPT",981,"RC",{"$nulls":6},"both",null,null,115.74,115.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},39.02,39.02,null,null,"facility"]
["Emergency Department Visit Low Mdm","PX-99283","CDM",99283,"CPT",981,"RC",{"$nulls":6},"both",null,null,196.95,196.95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},66.4,66.4,null,null,"facility"]
["Emergency Department Visit Moderate Mdm","PX-99284","CDM",99284,"CPT",981,"RC",{"$nulls":6},"both",null,null,335.04,335.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},112.97,112.97,null,null,"facility"]
["Emergency Department Visit High Mdm","PX-99285","CDM",99285,"CPT",981,"RC",{"$nulls":6},"both",null,null,485.31,485.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},163.63,163.63,null,null,"facility"]
["Critical Care Ill/Injured Patient Init 30-74 Min","PX-99291","CDM",99291,"CPT",981,"RC",{"$nulls":6},"both",null,null,778.05,778.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},199.97,261.21,null,null,"facility"]
["Critical Care Ill/Injured Patient Addl 30 Min","PX-99292","CDM",99292,"CPT",981,"RC",{"$nulls":6},"both",null,null,337.71,337.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},100.49,113.59,null,null,"facility"]
["Lh Troponin, Quantitative","PX-LH84484","CDM",84484,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hep B Surface Ag Neutrlzj Ia","PX-LH87341","CDM",87341,"CPT",300,"RC",{"$nulls":6},"both",null,null,78,78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Von Willebrand Factor Activity","PX-LH85397","CDM",85397,"CPT",300,"RC",{"$nulls":6},"both",null,null,92.58,92.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Interleukin 6","PX-LH83529","CDM",83529,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Clot Factor VIII Multimetric","PX-LH85247","CDM",85247,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fibrinolysins Screen I&R","PX-LH85390","CDM",85390,"CPT",300,"RC",{"$nulls":6},"both",null,null,46.44,46.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Clot Factor VIII Ahg 1 Stage","PX-LH85240","CDM",85240,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gip (Gastrointestinal Panel) 6-11 Targets","PX-LH87506","CDM",87506,"CPT",300,"RC",{"$nulls":6},"both",null,null,788.97,788.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gip (Gastrointestinal Panel) 12-25 Targets","PX-LH87507","CDM",87507,"CPT",300,"RC",{"$nulls":6},"both",null,null,833.56,833.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cytomegalovirus Amplified Probe Technique","PX-LH87496","CDM",87496,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mpl Gene Seq Alys Exon 10","PX-LH81339","CDM",81339,"CPT",300,"RC",{"$nulls":6},"both",null,null,370.4,370.4,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Calr Gene Com Variants","PX-LH81219","CDM",81219,"CPT",300,"RC",{"$nulls":6},"both",null,null,425.71,425.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mitochondrial Antibody Each","PX-LH86381","CDM",86381,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Actin Antibody Each","PX-LH86015","CDM",86015,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.15,36.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lactoferrin Fecal (Quant)","PX-LH83631","CDM",83631,"CPT",300,"RC",{"$nulls":6},"both",null,null,157,157,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fetal Chrmoml Aneuploidy","PX-LH81420","CDM",81420,"CPT",300,"RC",{"$nulls":6},"both",null,null,2277.15,2277.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T Cells Total Count","PX-LH86359","CDM",86539,"CPT",300,"RC",{"$nulls":6},"both",null,null,37.98,37.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T Cell Absolute Count/Ratio","PX-LH86360","CDM",86360,"CPT",300,"RC",{"$nulls":6},"both",null,null,140.94,140.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chemiluminescent Assay","PX-LH82397","CDM",82397,"CPT",300,"RC",{"$nulls":6},"both",null,null,42.36,42.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dna/Rna Amplified Probe","PX-LH87150","CDM",87150,"CPT",300,"RC",{"$nulls":6},"both",null,null,285,285,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Assay of Vip","PX-LH84586","CDM",84586,"CPT",300,"RC",{"$nulls":6},"both",null,null,287,287,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Test Def 22+ Classes","PX-LHG0483","CDM","G0483","HCPCS",300,"RC",{"$nulls":6},"both",null,null,740.76,740.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Assay Methotrexate","PX-LH80204","CDM",80204,"CPT",300,"RC",{"$nulls":6},"both",null,null,115.71,115.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza a/B Each Ag Ia","PX-LH87400","CDM",87400,"CPT",300,"RC",{"$nulls":6},"both",null,null,42.39,42.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Strep a Ag Ia","PX-LH87430","CDM",87430,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.43,50.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Resp Syncytial Virus Ag Ia","PX-LH87420","CDM",87420,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.73,41.73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Admin Pneumococcal Vaccine","PX-G0009","CDM","G0009","HCPCS",982,"RC",{"$nulls":6},"both",null,null,95.76,95.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colorectal Scrn; Hi Risk Ind","PX-G0105","CDM","G0105","HCPCS",975,"RC",{"$nulls":6},"both",null,null,975.48,975.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},171.81,327.02,null,null,"facility"]
["Lh Cytopathology, in Situ Hybridization (Eg, Fish)","PX-LH88120","CDM",88120,"CPT",300,"RC",{"$nulls":6},"both",null,null,514.08,514.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Opioid &Opiate Analog 5/More","PX-LH80364","CDM",80364,"CPT",300,"RC",{"$nulls":6},"both",null,null,173,173,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colon Ca Scrn Not Hi Rsk Ind","PX-G0121","CDM","G0121","HCPCS",975,"RC",{"$nulls":6},"both",null,null,975.87,975.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},171.98,327.19,null,null,"facility"]
["Lh Cystatin C","PX-LH82610","CDM",82610,"CPT",300,"RC",{"$nulls":6},"both",null,null,79,79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mopath Procedure Level 9","PX-LH81408","CDM",81408,"CPT",300,"RC",{"$nulls":6},"both",null,null,6000,6000,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ldct Eligibility Visit","PX-G0296","CDM","G0296","HCPCS",521,"RC",{"$nulls":6},"both",null,null,79.71,79.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},24.08,26.7,null,null,"facility"]
["Lh Hemophilus Influenza Antibdy","PX-LH86684","CDM",86684,"CPT",300,"RC",{"$nulls":6},"both",null,null,58,58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Asy Thiopurin S-Mthyltrnsfrs","PX-LH84433","CDM",84433,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Assay of Estrone","PX-LH82679","CDM",82679,"CPT",300,"RC",{"$nulls":6},"both",null,null,176,176,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ihc Icc, per Speciman Ea Addl Stain","PX-LH88341","CDM",88341,"CPT",300,"RC",{"$nulls":6},"both",null,null,239,239,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lacosamide Serum or Plasma","PX-LH80235","CDM",80235,"CPT",301,"RC",{"$nulls":6},"both",null,null,115,115,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Androstenedione","PX-LH82157","CDM",82157,"CPT",300,"RC",{"$nulls":6},"both",null,null,226,226,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cytogenetics Interpretation","PX-LH88291","CDM",88291,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Plasminogen Activator Inhibitor","PX-LH85415","CDM",85415,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.6,51.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fibrin(Ogen) Degradation (Split) Products (Fdp)(Fsp); Paracoagulation","PX-LH85366","CDM",85366,"CPT",300,"RC",{"$nulls":6},"both",null,null,67,67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh F2 (Prothrombin, Coagulation Factor II) Gene Analysis, 20210g>a Variant","PX-LH81240","CDM",81240,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor","PX-LH86041","CDM",86041,"CPT",300,"RC",{"$nulls":6},"both",null,null,55.2,55.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Test Def 1-7 Classes","PX-LH80339","CDM",80339,"CPT",300,"RC",{"$nulls":6},"both",null,null,98,98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chromogranin A","PX-LH86316","CDM",86316,"CPT",300,"RC",{"$nulls":6},"both",null,null,158,158,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Apolipoprotein B","PX-LH82172","CDM",82172,"CPT",300,"RC",{"$nulls":6},"both",null,null,63.27,63.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh PR Western Blot","PX-LH84182","CDM",84182,"CPT",300,"RC",{"$nulls":6},"both",null,null,147,147,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flow Cytometry Interpretation","PX-LH88187","CDM",88187,"CPT",300,"RC",{"$nulls":6},"both",null,null,244.14,244.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Respiratory Pathogen Panel by Nat","PX-LH0202U","CDM","0202U","CPT",300,"RC",{"$nulls":6},"both",null,null,1250.34,1250.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor (Achr) Modulating Antibody","PX-LH86043","CDM",86043,"CPT",300,"RC",{"$nulls":6},"both",null,null,37.35,37.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hla I Typing 1 Allele Hr","PX-LH81381","CDM",81381,"CPT",300,"RC",{"$nulls":6},"both",null,null,509.7,509.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC US Guidance/Ndl Placement","PX-4020051","CDM",76942,"CPT",402,"RC",{"$nulls":6},"both",null,null,393.36,393.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Tube Thoracostomy Includes Water Seal","PX-32551","CDM",32551,"CPT",982,"RC",{"$nulls":6},"both",null,null,418.71,418.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},141.91,141.91,null,null,"facility"]
["Room & Nursing","PX-1210000","CDM",null,null,120,"RC",{"$nulls":6},"both",null,null,4652.5,4652.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Icu Room & Nursing","PX-2000000","CDM",null,null,200,"RC",{"$nulls":6},"both",null,null,5897.5,5897.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Sclerotherapy Spider Veins","PX-3200000","CDM",36468,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Mandible <4 Views","PX-3200226","CDM",70100,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Mandible 4+ Views","PX-3200228","CDM",70110,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Facial Bones 3+ Views","PX-3200004","CDM",70150,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Nose Bones 3+ Views","PX-3200005","CDM",70160,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Orbits Min 4 Views","PX-3200006","CDM",70200,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Sinuses < 3 Views","PX-3200007","CDM",70210,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Sinuses 3+ Views","PX-3200008","CDM",70220,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Skull <4 Views","PX-3200009","CDM",70250,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Skull 4+ Views","PX-3200010","CDM",70260,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Tmj","PX-3200011","CDM",70330,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Soft Tissue Neck","PX-3200013","CDM",70360,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Sterno-Clav Jts Min 3 V","PX-3200230","CDM",71130,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Spine Single View","PX-3200232","CDM",72020,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Spine 2/3 Views","PX-3200233","CDM",72040,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Spine 4/5 Views","PX-3200017","CDM",72050,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Spine 6+ Views","PX-3200018","CDM",72052,"CPT",320,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Thoracic Spine 3 Views","PX-3200020","CDM",72072,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Thoracic Spine W Obliques","PX-3200021","CDM",72074,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Trunk Spine 2 Views","PX-3200022","CDM",72080,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Lumbar Spine 2 Views","PX-3200024","CDM",72100,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Lumbar Spine","PX-3200025","CDM",72110,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Lower Spine","PX-3200026","CDM",72114,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Lumbar Bending 4views","PX-3200027","CDM",72120,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Pelvis","PX-3200028","CDM",72170,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pelvis Minimum 3 Views","PX-3200029","CDM",72190,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Sacroiliac Joints","PX-3200030","CDM",72200,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Sacroiliac Joints","PX-3200031","CDM",72202,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Sacrum & Coccyx","PX-3200032","CDM",72220,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Clavicle","PX-3200041","CDM",73000,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Scapula","PX-3200042","CDM",73010,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Shoulder","PX-3200043","CDM",73020,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Shoulder","PX-3200044","CDM",73030,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Ac Joints","PX-3200046","CDM",73050,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Humerus","PX-3200047","CDM",73060,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Elbow","PX-3200048","CDM",73070,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Elbow","PX-3200049","CDM",73080,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Forearm","PX-3200051","CDM",73090,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Wrist","PX-3200053","CDM",73100,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Wrist","PX-3200054","CDM",73110,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Hand","PX-3200056","CDM",73120,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Hand","PX-3200057","CDM",73130,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Finger","PX-3200058","CDM",73140,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Knee","PX-3200067","CDM",73560,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Knee","PX-3200068","CDM",73562,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Knee","PX-3200069","CDM",73564,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Knees-Standing","PX-3200070","CDM",73565,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Lower Leg","PX-3200072","CDM",73590,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Ankle","PX-3200075","CDM",73600,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Ankle","PX-3200076","CDM",73610,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Foot","PX-3200078","CDM",73620,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Foot","PX-3200079","CDM",73630,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Heel","PX-3200080","CDM",73650,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Toe(S)","PX-3200081","CDM",73660,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Abdomen","PX-3200084","CDM",74022,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Fluro Guid Ndl Plcmnt","PX-3200204","CDM",77002,"CPT",320,"RC",{"$nulls":6},"both",null,null,617.2,617.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bone Survey Lmtd","PX-3200214","CDM",77074,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bone Survey Complete","PX-3200215","CDM",77075,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Osseous Survey Infant","PX-3200216","CDM",77076,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Joint Survey,Sngl V,2 or M Joints","PX-3200217","CDM",77077,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Dexascan","PX-3200218","CDM",77080,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Ribs 2 Views","PX-3240007","CDM",71100,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Ribs 3+ Views","PX-3240008","CDM",71101,"CPT",324,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Ribs 3 Views","PX-3240009","CDM",71110,"CPT",324,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Ribs 4 Views","PX-3240010","CDM",71111,"CPT",320,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xr-Sternum 2+ Views","PX-3240011","CDM",71120,"CPT",320,"RC",{"$nulls":6},"both",null,null,259.74,259.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3310000","CDM",96401,"CPT",260,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3310001","CDM",96402,"CPT",331,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3350002","CDM",96413,"CPT",335,"RC",{"$nulls":6},"both",null,null,995.07,995.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3350003","CDM",96415,"CPT",335,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Parathyroid Imaging","PX-3410005","CDM",78070,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Bone Limited","PX-3410025","CDM",78300,"CPT",340,"RC",{"$nulls":6},"both",null,null,1178.91,1178.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Bone Scan","PX-3410026","CDM",78305,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Bone Scan","PX-3410027","CDM",78306,"CPT",340,"RC",{"$nulls":6},"both",null,null,1178.91,1178.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Bone Scan","PX-3410028","CDM",78315,"CPT",340,"RC",{"$nulls":6},"both",null,null,1178.91,1178.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Venogram Bilateral","PX-3410033","CDM",78458,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cardiac Blood Pool (Muga)","PX-3410039","CDM",78472,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Muga Scan","PX-3410040","CDM",78473,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Perfusion Lung","PX-3410046","CDM",78580,"CPT",340,"RC",{"$nulls":6},"both",null,null,1178.91,1178.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Brain Flow Image","PX-3410052","CDM",78610,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Renal Scan","PX-3410057","CDM",78700,"CPT",340,"RC",{"$nulls":6},"both",null,null,1178.91,1178.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Renogram","PX-3410058","CDM",78707,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Mag3 Renogram W Pharm","PX-3410059","CDM",78708,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Nuc Med Cystogram","PX-3410062","CDM",78740,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Testicular Image","PX-3410063","CDM",78761,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tumor;Spect","PX-3410067","CDM",78803,"CPT",341,"RC",{"$nulls":6},"both",null,null,3758.79,3758.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NM Cardiolite per Syringe","PX-3430001","CDM","A9500","HCPCS",636,"RC",{"$nulls":6},"both",null,null,219,219,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Mdp per Dose","PX-3430003","CDM","A9503","HCPCS",340,"RC",{"$nulls":6},"both",null,null,116,116,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Choletec per Dose","PX-3430011","CDM","A9537","HCPCS",343,"RC",{"$nulls":6},"both",null,null,355,355,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500000","CDM",70490,"CPT",350,"RC",{"$nulls":6},"both",null,null,1420,1420,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500001","CDM",70491,"CPT",350,"RC",{"$nulls":6},"both",null,null,1690,1690,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500002","CDM",70492,"CPT",350,"RC",{"$nulls":6},"both",null,null,2070,2070,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Chest","PX-3500005","CDM",71275,"CPT",350,"RC",{"$nulls":6},"both",null,null,2210,2210,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Cervical Spine","PX-3500006","CDM",72126,"CPT",350,"RC",{"$nulls":6},"both",null,null,1700,1700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Cervical Spine","PX-3500007","CDM",72127,"CPT",352,"RC",{"$nulls":6},"both",null,null,1703,1703,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Thoracic Spine","PX-3500008","CDM",72128,"CPT",350,"RC",{"$nulls":6},"both",null,null,1390,1390,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Thoracic Spine","PX-3500009","CDM",72129,"CPT",350,"RC",{"$nulls":6},"both",null,null,1660,1660,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Thoracic Spine","PX-3500010","CDM",72130,"CPT",350,"RC",{"$nulls":6},"both",null,null,1127.18,1127.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Lumbar Spine","PX-3500011","CDM",72131,"CPT",350,"RC",{"$nulls":6},"both",null,null,1380,1380,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Lumbar Spine","PX-3500012","CDM",72132,"CPT",350,"RC",{"$nulls":6},"both",null,null,1700,1700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC CT Spine Lumbar W/WO Dye","PX-3500013","CDM",72133,"CPT",350,"RC",{"$nulls":6},"both",null,null,1173.53,1173.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Upper Extremity","PX-3500016","CDM",73200,"CPT",350,"RC",{"$nulls":6},"both",null,null,1380,1380,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Upper Extremity","PX-3500017","CDM",73201,"CPT",350,"RC",{"$nulls":6},"both",null,null,2427.07,2427.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Upper Extremity","PX-3500018","CDM",73202,"CPT",350,"RC",{"$nulls":6},"both",null,null,1380,1380,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Lower Extremity","PX-3500020","CDM",73700,"CPT",350,"RC",{"$nulls":6},"both",null,null,1320,1320,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Lower Extremity","PX-3500021","CDM",73701,"CPT",350,"RC",{"$nulls":6},"both",null,null,1700,1700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Lower Extremity","PX-3500022","CDM",73702,"CPT",350,"RC",{"$nulls":6},"both",null,null,2170,2170,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Brain","PX-3510000","CDM",70450,"CPT",351,"RC",{"$nulls":6},"both",null,null,1050,1050,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Brain","PX-3510001","CDM",70460,"CPT",351,"RC",{"$nulls":6},"both",null,null,1100,1100,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Brain","PX-3510002","CDM",70470,"CPT",351,"RC",{"$nulls":6},"both",null,null,1360,1360,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Ear","PX-3510003","CDM",70480,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Ear","PX-3510004","CDM",70481,"CPT",351,"RC",{"$nulls":6},"both",null,null,2210,2210,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Ear","PX-3510005","CDM",70482,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Facial Bone","PX-3510006","CDM",70486,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Facial Bones","PX-3510007","CDM",70487,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Facial Bones","PX-3510008","CDM",70488,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Thorax","PX-3520000","CDM",71250,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Thorax","PX-3520002","CDM",71270,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Cervical Spine","PX-3520003","CDM",72125,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Pelvis","PX-3520004","CDM",72192,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Pelvis","PX-3520005","CDM",72193,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Pelvis","PX-3520006","CDM",72194,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.56,1204.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520007","CDM",74150,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520008","CDM",74160,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520009","CDM",74170,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Thorax","PX-3520010","CDM",71260,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Trigger Point,3 or More","PX-3600000","CDM",20553,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Blood Admin 2+ Hrs","PX-3910000","CDM",36430,"CPT",391,"RC",{"$nulls":6},"both",null,null,1311.54,1311.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Echo Exam of Head","PX-4020000","CDM",76506,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.25,319.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Exam Head/Neck","PX-4020004","CDM",76536,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Exam Abdomen Complete","PX-4020007","CDM",76700,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Exam Abdomen Lmtd","PX-4020008","CDM",76705,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Renal Complete","PX-4020009","CDM",76770,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Renal Lmtd","PX-4020010","CDM",76775,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US OB Complete(<14 Wks)","PX-4020013","CDM",76801,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Multiple Gestation(<14 Wks)","PX-4020014","CDM",76802,"CPT",402,"RC",{"$nulls":6},"both",null,null,600,600,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Pregnancy Complete","PX-4020015","CDM",76805,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Pregnancy Cmplt Addl Fetus","PX-4020016","CDM",76810,"CPT",402,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Pregnancy Lmtd","PX-4020017","CDM",76815,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Follow Up/Repeat OB","PX-4020018","CDM",76816,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Transvaginal OB","PX-4020019","CDM",76817,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bio Profile","PX-4020020","CDM",76819,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Transvaginal","PX-4020022","CDM",76830,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Pelvic Complete","PX-4020024","CDM",76856,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Pelvic Limited","PX-4020025","CDM",76857,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Scrotum","PX-4020026","CDM",76870,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Prostate Transrectal","PX-4020027","CDM",76872,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC US Guidance/Ndl Placement","PX-4020035","CDM",76942,"CPT",761,"RC",{"$nulls":6},"both",null,null,393.36,393.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ventilation Assist,Initial","PX-4100000","CDM",94002,"CPT",410,"RC",{"$nulls":6},"both",null,null,1791.24,1791.24,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Airway Inhalation Trmt","PX-4100003","CDM",94640,"CPT",410,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cpap/Day","PX-4100007","CDM",94660,"CPT",760,"RC",{"$nulls":6},"both",null,null,609.66,609.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Demo/Eval-Aerosol","PX-4100008","CDM",94664,"CPT",410,"RC",{"$nulls":6},"both",null,null,609.66,609.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Chest Physiotherapy,Initial","PX-4100009","CDM",94667,"CPT",410,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Chest Physiotherapy,Subsequent","PX-4100010","CDM",94668,"CPT",410,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Traction","PX-4200004","CDM",97012,"CPT",420,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Unattend E-Stim","PX-4200005","CDM",97014,"CPT",420,"RC",{"$nulls":6},"both",null,null,33.78,33.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Gait Training","PX-4200009","CDM",97116,"CPT",420,"RC",{"$nulls":6},"both",null,null,85.83,85.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ortho Mgt/Training Initial","PX-4200012","CDM",97760,"CPT",420,"RC",{"$nulls":6},"both",null,null,139.86,139.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Vasopneumatic Device","PX-4300001","CDM",97016,"CPT",420,"RC",{"$nulls":6},"both",null,null,33.78,33.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Whirlpool","PX-4300003","CDM",97022,"CPT",420,"RC",{"$nulls":6},"both",null,null,89,89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["E-Stim 15 Min","PX-4300005","CDM",97032,"CPT",430,"RC",{"$nulls":6},"both",null,null,77,77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Iontophoresis 15 Min","PX-4300006","CDM",97033,"CPT",430,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Contrast Bath 15 Min","PX-4300007","CDM",97034,"CPT",430,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ultrasound 15 Min","PX-4300008","CDM",97035,"CPT",430,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Therap Exercise 15min","PX-4300010","CDM",97110,"CPT",430,"RC",{"$nulls":6},"both",null,null,85.83,85.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Neuromusc Re-ED 15min","PX-4300011","CDM",97112,"CPT",430,"RC",{"$nulls":6},"both",null,null,98.61,98.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Manual Therapy 15min","PX-4300013","CDM",97140,"CPT",430,"RC",{"$nulls":6},"both",null,null,78.96,78.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Therapy Activity 15min","PX-4300015","CDM",97530,"CPT",430,"RC",{"$nulls":6},"both",null,null,107.46,107.46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC S I Techniques 15 Min","PX-4300017","CDM",97533,"CPT",430,"RC",{"$nulls":6},"both",null,null,183.09,183.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Self-Care/Hm Mgmt Tx 15min","PX-4300018","CDM",97535,"CPT",430,"RC",{"$nulls":6},"both",null,null,95.67,95.67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Com/Work Re-Integra 15 Min","PX-4300019","CDM",97537,"CPT",430,"RC",{"$nulls":6},"both",null,null,92.7,92.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Wheelchair Mgmt/Prop 15 Min","PX-4300020","CDM",97542,"CPT",430,"RC",{"$nulls":6},"both",null,null,92.7,92.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Work Hardening","PX-4300021","CDM",97545,"CPT",430,"RC",{"$nulls":6},"both",null,null,196.41,196.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Work Hardening Add-On","PX-4300022","CDM",97546,"CPT",430,"RC",{"$nulls":6},"both",null,null,98.54,98.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Debridement","PX-4300023","CDM",97597,"CPT",430,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Select Debride > 20 Sq Cent","PX-4300024","CDM",97598,"CPT",430,"RC",{"$nulls":6},"both",null,null,341.41,341.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Debridement","PX-4300025","CDM",97602,"CPT",430,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC E-Stim-Unattended","PX-4300029","CDM","G0283","HCPCS",430,"RC",{"$nulls":6},"both",null,null,33.78,33.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Speech/Hearing Therapy","PX-4400001","CDM",92507,"CPT",440,"RC",{"$nulls":6},"both",null,null,223.14,223.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Speech/Hearing Therapy Group","PX-4400002","CDM",92508,"CPT",440,"RC",{"$nulls":6},"both",null,null,71.1,71.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Dysphagia Study","PX-4400003","CDM",92526,"CPT",440,"RC",{"$nulls":6},"both",null,null,247.68,247.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Swallowing Eval","PX-4400007","CDM",92610,"CPT",440,"RC",{"$nulls":6},"both",null,null,249.06,249.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Aphasia Assessment per Hr","PX-4400010","CDM",96105,"CPT",440,"RC",{"$nulls":6},"both",null,null,278.67,278.67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Dev/Test-Limited","PX-4400011","CDM",96110,"CPT",430,"RC",{"$nulls":6},"both",null,null,148.99,148.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Evacuation Subungual Hematoma","PX-4500001","CDM",11740,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Body 12.6-20","PX-4500002","CDM",12005,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Body 20.1-30","PX-4500003","CDM",12006,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 5.1-7.5","PX-4500004","CDM",12014,"CPT",360,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Scalp,Extr 1.1-2.5","PX-4500007","CDM",13120,"CPT",360,"RC",{"$nulls":6},"both",null,null,1836.39,1836.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Clavicle Fracture","PX-4500013","CDM",23500,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Mid Humerus Fracture","PX-4500016","CDM",24500,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Mid Humerus Fx,Manipulatn","PX-4500017","CDM",24505,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Elbow Dislocation","PX-4500021","CDM",24600,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Radial Head Disloc,Child","PX-4500022","CDM",24640,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Prox Ulna Fracture","PX-4500023","CDM",24670,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Ulna Shaft Fx","PX-4500024","CDM",25530,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Rad/Ulna Shaft Fx","PX-4500025","CDM",25560,"CPT",360,"RC",{"$nulls":6},"both",null,null,719.64,719.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx MC-P Disloc","PX-4500029","CDM",26700,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx IP Jt Dislocation","PX-4500030","CDM",26770,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Post Hip Arthrplas Disloc","PX-4500032","CDM",27265,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Treat Kneecap Dislocation","PX-4500037","CDM",27560,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Fibula Fx","PX-4500105","CDM",27786,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Mt-Phal Toe Dislocation","PX-4500041","CDM",28630,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Long Arm Cast","PX-4500106","CDM",29065,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Forearm Cast","PX-4500043","CDM",29075,"CPT",361,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Hand/Wrist Cast","PX-4500044","CDM",29085,"CPT",360,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Long Arm Splint","PX-4500045","CDM",29105,"CPT",521,"RC",{"$nulls":6},"both",null,null,473.37,473.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Forearm Splint,Static","PX-4500046","CDM",29125,"CPT",450,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Finger Splint","PX-4500048","CDM",29130,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Strapping of Shoulder","PX-4500049","CDM",29240,"CPT",420,"RC",{"$nulls":6},"both",null,null,86.22,86.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Long Leg Cast","PX-4500051","CDM",29345,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Apply Short Leg Cast","PX-4500052","CDM",29405,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Short Leg Cast,Walker","PX-4500053","CDM",29425,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Long Leg Splint","PX-4500054","CDM",29505,"CPT",360,"RC",{"$nulls":6},"both",null,null,473.37,473.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Apply Lower Leg Splint","PX-4500055","CDM",29515,"CPT",360,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv/Revisn Boot/Body Cast","PX-4500056","CDM",29700,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv/Revisn Full Arm/Leg Cast","PX-4500057","CDM",29705,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Nasal Foreign Body","PX-4500060","CDM",30300,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Initial","PX-4500061","CDM",30905,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Subsequent","PX-4500062","CDM",30906,"CPT",360,"RC",{"$nulls":6},"both",null,null,698.19,698.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Plcmt of Needle Intraosseo","PX-4500067","CDM",36680,"CPT",360,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Insert Bladder Catheter","PX-4500077","CDM",51701,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Insert Temp Bladder Catheter","PX-4500078","CDM",51702,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv Ext Canal Foreign Body","PX-4500090","CDM",69200,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CPR","PX-4500092","CDM",92950,"CPT",360,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC TPA","PX-4500094","CDM",92977,"CPT",360,"RC",{"$nulls":6},"both",null,null,968.04,968.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ipecac Administration","PX-4500095","CDM",99175,"CPT",450,"RC",{"$nulls":6},"both",null,null,154.25,154.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ED Level I","PX-4500096","CDM",99281,"CPT",450,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ED Level II","PX-4500097","CDM",99282,"CPT",450,"RC",{"$nulls":6},"both",null,null,475.08,475.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ED Level III","PX-4500098","CDM",99283,"CPT",450,"RC",{"$nulls":6},"both",null,null,830.67,830.67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ED Level IV","PX-4500099","CDM",99284,"CPT",450,"RC",{"$nulls":6},"both",null,null,1277.46,1277.46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ED Level V","PX-4500100","CDM",99285,"CPT",450,"RC",{"$nulls":6},"both",null,null,1839.3,1839.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Critical Care 1st Hour","PX-4500101","CDM",99291,"CPT",450,"RC",{"$nulls":6},"both",null,null,2057,2057,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Wound Clos/Tissue Adhesiv Only","PX-4500102","CDM","G0168","HCPCS",490,"RC",{"$nulls":6},"both",null,null,355.89,355.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Debride Infected Skin","PX-4560000","CDM",11000,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Spirometry","PX-4600000","CDM",94010,"CPT",460,"RC",{"$nulls":6},"both",null,null,446.49,446.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Pre/Post Spiro","PX-4600002","CDM",94060,"CPT",460,"RC",{"$nulls":6},"both",null,null,897.18,897.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cardioversion","PX-4800000","CDM",92960,"CPT",450,"RC",{"$nulls":6},"both",null,null,1860.3,1860.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tte W/Doppler Complete","PX-4800009","CDM",93306,"CPT",480,"RC",{"$nulls":6},"both",null,null,1576.89,1576.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Echo Exam Complete","PX-4800010","CDM",93307,"CPT",480,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Echo Exam Limited","PX-4800011","CDM",93308,"CPT",483,"RC",{"$nulls":6},"both",null,null,725.16,725.16,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Doppler Echo Exam Complete","PX-4800014","CDM",93320,"CPT",480,"RC",{"$nulls":6},"both",null,null,649.3,649.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Doppler Color Flow Addon","PX-4800016","CDM",93325,"CPT",480,"RC",{"$nulls":6},"both",null,null,552.78,552.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Echo Transthoracic","PX-4800017","CDM",93350,"CPT",483,"RC",{"$nulls":6},"both",null,null,1644.9,1644.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Stress Test","PX-4820000","CDM",93017,"CPT",482,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC I & D Abscess, Smpl","PX-4900003","CDM",10060,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC I & D Abscess, Cmplx","PX-4900004","CDM",10061,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC I & D Pilonidal Cyst,Smpl","PX-4900005","CDM",10080,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC I & D Pilonidal Cyst,Cmplx","PX-4900006","CDM",10081,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Foreign Body,Smpl","PX-4900007","CDM",10120,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Foreign Body,Cmplx","PX-4900008","CDM",10121,"CPT",450,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Drainage of Hematoma/Fluid","PX-4900009","CDM",10140,"CPT",450,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Puncture Drainage of Lesion","PX-4900010","CDM",10160,"CPT",361,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Debride Skin/Tissue","PX-4900022","CDM",11042,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Debride Tissue/Muscle","PX-4900023","CDM",11043,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Trim Skin Lesion","PX-4900025","CDM",11055,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Skin Tags","PX-4900028","CDM",11200,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Skin Tags Add-On","PX-4900029","CDM",11201,"CPT",761,"RC",{"$nulls":6},"both",null,null,215.38,215.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les <5mm Trunk,Arm,Leg","PX-4900030","CDM",11300,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Trunk,Arm,Leg","PX-4900031","CDM",11301,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les 11-20mm Trunk,Arm,Leg","PX-4900032","CDM",11302,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les >21mm Trunk,Arm,Leg","PX-4900033","CDM",11303,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les <5mm Remaindr Body","PX-4900034","CDM",11305,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Remaindr Body","PX-4900035","CDM",11306,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les 11-20mm Remaindr Body","PX-4900036","CDM",11307,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les >21mm Remaindr Body","PX-4900037","CDM",11308,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les <5mm Face,Facial","PX-4900038","CDM",11310,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Face,Facial","PX-4900039","CDM",11311,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les 11-20mm Face,Facial","PX-4900040","CDM",11312,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Shav Skin Les >21mm Face,Facial","PX-4900041","CDM",11313,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Benig .1-.5cm Trunk,Arm,Leg","PX-4900042","CDM",11400,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 0.6-1cm Trunk,Arm,Le","PX-4900043","CDM",11401,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Trunk,Arm,Leg","PX-4900044","CDM",11402,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 2.1-3cm Trunk,Arm,Le","PX-4900045","CDM",11403,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 3.1-4cm Trunk,Arm,Le","PX-4900046","CDM",11404,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig >4cm Trunk,Arm,Leg","PX-4900047","CDM",11406,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig <5mm Remaindr Body","PX-4900048","CDM",11420,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 0.6-1cm Remaindr Bod","PX-4900049","CDM",11421,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Remaindr Bod","PX-4900050","CDM",11422,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 2.1-3cm Remaindr Bod","PX-4900051","CDM",11423,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 3.1-4cm Remaindr Bod","PX-4900052","CDM",11424,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig >4cm Remaindr Body","PX-4900053","CDM",11426,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig <5mm Face,Facial","PX-4900054","CDM",11440,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 0.6-1cm Face,Facial","PX-4900055","CDM",11441,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Face,Facial","PX-4900056","CDM",11442,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 2.1-3cm Face,Facial","PX-4900057","CDM",11443,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 3.1-4cm Face,Facial","PX-4900058","CDM",11444,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig >4cm Face,Facial","PX-4900059","CDM",11446,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig <5mm Trunk,Arm,Leg","PX-4900065","CDM",11600,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Trunk,Arm,Leg","PX-4900066","CDM",11601,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 1.1-2cm Trunk,Arm,Le","PX-4900067","CDM",11602,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 2.1-3cm Trunk,Arm,Leg","PX-4900068","CDM",11603,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 3.1-4cm Trunk,Arm,Leg","PX-4900069","CDM",11604,"CPT",361,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig >4cm Trunk,Arm,Leg","PX-4900070","CDM",11606,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Remaindr Bod","PX-4900072","CDM",11621,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 1.1-2cm Remaindr Bod","PX-4900073","CDM",11622,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 2.1-3cm Remaindr Body","PX-4900074","CDM",11623,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 3.1-4cm Remaindr Body","PX-4900075","CDM",11624,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig >4cm Remaindr Body","PX-4900076","CDM",11626,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig <5cm Face,Facial","PX-4900077","CDM",11640,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Face,Facial","PX-4900078","CDM",11641,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 1.1-2cm Face,Facial","PX-4900079","CDM",11642,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 2.1-3cm Face,Facial","PX-4900080","CDM",11643,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 3.1-4cm Face,Facial","PX-4900081","CDM",11644,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig >4cm Face,Facial","PX-4900082","CDM",11646,"CPT",360,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Facial Nerve Block","PX-4900085","CDM",11730,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Nail Plate Add-On","PX-4900086","CDM",11732,"CPT",450,"RC",{"$nulls":6},"both",null,null,334.41,334.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Nail Bed","PX-4900087","CDM",11750,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair Nail Bed","PX-4900090","CDM",11760,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excision of Nail Fold, Toe","PX-4900092","CDM",11765,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Smpl","PX-4900093","CDM",11770,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Extens","PX-4900094","CDM",11771,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Complic","PX-4900095","CDM",11772,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inject Skin Lesions","PX-4900096","CDM",11900,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inject Skin Lesions Add-On","PX-4900097","CDM",11901,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Contraceptive Cap","PX-4900107","CDM",11976,"CPT",360,"RC",{"$nulls":6},"both",null,null,2110.77,2110.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Insert Drug Implant Device","PX-4900108","CDM",11981,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Drug Implant Device","PX-4900109","CDM",11982,"CPT",360,"RC",{"$nulls":6},"both",null,null,1197.13,1197.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Body <2.5cm","PX-4900110","CDM",12001,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Sup Npterf Wnd Body 2.6-7.5","PX-4900111","CDM",12002,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Body 7.6-12.5","PX-4900112","CDM",12004,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face <2.5cm","PX-4900114","CDM",12011,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 2.6-5","PX-4900115","CDM",12013,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 7.6-12.5","PX-4900116","CDM",12015,"CPT",360,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closure Superf Wnd Dehis Smpl","PX-4900119","CDM",12020,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg <2.5cm","PX-4900120","CDM",12031,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg 2.6-7.5","PX-4900121","CDM",12032,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg 7.6-12.","PX-4900122","CDM",12034,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg 12.6-20","PX-4900123","CDM",12035,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg 20.1-30","PX-4900124","CDM",12036,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg >30cm","PX-4900125","CDM",12037,"CPT",360,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body <2.5cm","PX-4900126","CDM",12041,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 2.6-7.5","PX-4900127","CDM",12042,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 7.6-12.5","PX-4900128","CDM",12044,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 12.6-20","PX-4900129","CDM",12045,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 20.1-30","PX-4900130","CDM",12046,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Facial<2.5cm","PX-4900132","CDM",12051,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Face,Facial 2.5-5","PX-4900133","CDM",12052,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Face,Facial 5.1-7.5","PX-4900134","CDM",12053,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Face,Facial 7.6-12.5","PX-4900135","CDM",12054,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Trunk 2.6-7.5cm","PX-4900140","CDM",13101,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Scalp,Extr 2.6-7.5","PX-4900142","CDM",13121,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rep,Skin,Scalp/Extrem+5cm/<","PX-4900143","CDM",13122,"CPT",450,"RC",{"$nulls":6},"both",null,null,1251.16,1251.16,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Head,Fac,Hand 1.1-2.5","PX-4900144","CDM",13131,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Head,Fac,Hand 2.6-7.5","PX-4900145","CDM",13132,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rep,Face,Genital,Hand,Ft+5cm/<","PX-4900146","CDM",13133,"CPT",360,"RC",{"$nulls":6},"both",null,null,973.17,973.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Lid,Nos,Ear 2.5-7.5","PX-4900149","CDM",13152,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Adj Tiss Xfer Scalp,Extrem <10sqcm","PX-4900154","CDM",14020,"CPT",360,"RC",{"$nulls":6},"both",null,null,1737.53,1737.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Adj Tiss Xfer Head,Fac,Hand <10sqcm","PX-4900156","CDM",14040,"CPT",761,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Revision of Lower Eyelid","PX-4900204","CDM",15820,"CPT",360,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Revision of Upper Eyelid","PX-4900206","CDM",15822,"CPT",360,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Dress/Debrid Small Burn","PX-4900235","CDM",16020,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Dress/Debrid Med Burn No Anesth","PX-4900236","CDM",16025,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Dress/Debrid Large Burn No Anesth","PX-4900237","CDM",16030,"CPT",450,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destruct Premalg Lesion","PX-4900239","CDM",17000,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destruct Premalg Les, 2-14","PX-4900240","CDM",17003,"CPT",761,"RC",{"$nulls":6},"both",null,null,84.94,84.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destroy Premlg Lesions 15+","PX-4900241","CDM",17004,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destruct Benign Lesion, 1-14","PX-4900242","CDM",17110,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destruct Benign Lesion, 15+","PX-4900243","CDM",17111,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Chem Cautery Granulatn Tissue","PX-4900244","CDM",17250,"CPT",360,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Biopsy Breast W/O Image","PX-4900269","CDM",19100,"CPT",450,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Biopsy of Breast, Open","PX-4900270","CDM",19101,"CPT",761,"RC",{"$nulls":6},"both",null,null,10895.37,10895.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Breast Lesion","PX-4900274","CDM",19120,"CPT",450,"RC",{"$nulls":6},"both",null,null,10895.37,10895.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Explore Wound Extremity","PX-4900304","CDM",20103,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Foreign Body","PX-4900314","CDM",20520,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Therapeutic Inj, Carpal Tunnel","PX-4900316","CDM",20526,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Tendon Sheath/Ligament","PX-4900317","CDM",20550,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Tendon Origin/Insertion","PX-4900318","CDM",20551,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Trigger Point,1 or 2","PX-4900319","CDM",20552,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Drain/Inject Small Joint/Bursa","PX-4900320","CDM",20600,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Drain/Inject Medium Joint/Bursa","PX-4900321","CDM",20605,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rad Inject/Aspir Jntmajor","PX-4900322","CDM",20610,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Aspirate/Inj Ganglion Cyst","PX-4900323","CDM",20612,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Reduce Temporomandibl Disloc","PX-4900400","CDM",21480,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Lesion,Back or Flank","PX-4900412","CDM",21930,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Prox Humerus Fx,Manip","PX-4900456","CDM",23605,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Gr Tuberosity Hum Fx","PX-4900458","CDM",23620,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Shldr Dislocation","PX-4900461","CDM",23650,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Shldr Disloc,Anesthesia","PX-4900462","CDM",23655,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Drain Arm Bursa","PX-4900468","CDM",23931,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Elbow Bursa","PX-4900474","CDM",24105,"CPT",761,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Elbow Lesion","PX-4900477","CDM",24120,"CPT",761,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Elbow Dislocatn,Anesthesi","PX-4900510","CDM",24605,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Radial Head/Neck Fx","PX-4900514","CDM",24650,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Radial Head/Neck Fx,Manip","PX-4900515","CDM",24655,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Prox Ulna Fx,Manipulatn","PX-4900518","CDM",24675,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excis Primary Ganglion Wrist","PX-4900527","CDM",25111,"CPT",761,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Radial Shaft Fx","PX-4900566","CDM",25500,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx","PX-4900574","CDM",25600,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx,Manipul","PX-4900575","CDM",25605,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Navicular Fx","PX-4900580","CDM",25622,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Drain Finger Abscess,Smpl","PX-4900599","CDM",26010,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Tendon Sheath Lesion","PX-4900618","CDM",26160,"CPT",761,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Manipulate Finger With Anesth","PX-4900627","CDM",26340,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Metacarpal Fx","PX-4900678","CDM",26600,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Prox/Mid Fing Shft Fx","PX-4900690","CDM",26720,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Close Rx Prox/Mid Fing Shft Fx,Mani","PX-4900691","CDM",26725,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Amputation Finger/Thumb","PX-4900711","CDM",26951,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Amputation Finger/Thumb+Flaps","PX-4900712","CDM",26952,"CPT",450,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Injection Hip Arthrogram","PX-4900722","CDM",27093,"CPT",761,"RC",{"$nulls":6},"both",null,null,620.23,620.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Injection Sacroiliac Joint","PX-4900724","CDM",27096,"CPT",761,"RC",{"$nulls":6},"both",null,null,1791.84,1791.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Spont Hip Disloc,Anesth","PX-4900734","CDM",27257,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Foreign Body","PX-4900751","CDM",27372,"CPT",360,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Tibia Shaft Fx,Manipulatn","PX-4900829","CDM",27752,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Prox/Shaft Fibula Fx","PX-4900836","CDM",27780,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Fibula Fx,Manip","PX-4900839","CDM",27788,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Bimalleolar Fx","PX-4900841","CDM",27808,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Bimalleolar Fx,Manip","PX-4900842","CDM",27810,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Trimalleolar Fx,Manip","PX-4900844","CDM",27818,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Weight Bear Dist Tibia","PX-4900847","CDM",27824,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Ankle Dislocatn","PX-4900854","CDM",27840,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Explor Metatarso-Phalang Jt","PX-4900867","CDM",28022,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Foot Lesion Sngl Ea","PX-4900876","CDM",28080,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Foot Lesion,Tendon,Shealth,Capsule","PX-4900879","CDM",28090,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Full Excis 5th Metatarsal Head","PX-4900887","CDM",28113,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Heel Spur","PX-4900891","CDM",28119,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Partial Removal of Ankle/Heel","PX-4900892","CDM",28120,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Partial Removal of Foot Bone","PX-4900893","CDM",28122,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Part Remv Phalanx of Toe","PX-4900894","CDM",28124,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv Foot Foreign Body,Subcutaneous","PX-4900899","CDM",28190,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair Exten Leg Tendon,Prim,Ea","PX-4900903","CDM",28208,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Revision of Foot Tendon","PX-4900908","CDM",28238,"CPT",361,"RC",{"$nulls":6},"both",null,null,20448.99,20448.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair of Hammertoe","PX-4900913","CDM",28285,"CPT",361,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Part Removal of Foot Bone","PX-4900914","CDM",28288,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair Hallux Rigidus","PX-4900915","CDM",28289,"CPT",361,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Correct Bunion,Metatarsal Osteotomy","PX-4900919","CDM",28296,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Correct Bunion,Phalanx Osteotomy","PX-4900921","CDM",28298,"CPT",360,"RC",{"$nulls":6},"both",null,null,20448.99,20448.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Correct Bunion,Othr Methods","PX-4900922","CDM",28299,"CPT",360,"RC",{"$nulls":6},"both",null,null,20448.99,20448.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Osteotomy Metatarsal (Not 1st)","PX-4900926","CDM",28308,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Metatarsal Fx","PX-4900943","CDM",28470,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Smpl","PX-4901080","CDM",30901,"CPT",450,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Cmplx","PX-4901081","CDM",30903,"CPT",450,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Insert Emergency Airway","PX-4901106","CDM",31500,"CPT",450,"RC",{"$nulls":6},"both",null,null,698.19,698.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Esophagoscopy","PX-4902014","CDM",43200,"CPT",360,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Insertion of Chest Tube","PX-4901152","CDM",32551,"CPT",450,"RC",{"$nulls":6},"both",null,null,4577.79,4577.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Gastric Port,Open","PX-4902058","CDM",43887,"CPT",761,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excis Tongue Lesn,Ant 2/3+Clos","PX-4902071","CDM",41112,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Drainage of Gum Lesion","PX-4902089","CDM",41800,"CPT",761,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Intro Gastro Tube","PX-4902090","CDM",44500,"CPT",450,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excis Lesn,Palate/Uvula","PX-4902105","CDM",42104,"CPT",450,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Proctosigmoidoscopy,Dx","PX-4902116","CDM",45300,"CPT",360,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Incision of Anal Abscess","PX-4902134","CDM",46050,"CPT",761,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ligation of Hemorrhoid(S)","PX-4902146","CDM",46221,"CPT",761,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Anal Tags","PX-4902148","CDM",46230,"CPT",761,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Hemorrhoidectomy External","PX-4902150","CDM",46250,"CPT",761,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Anal Fistula Subcut","PX-4902165","CDM",46270,"CPT",360,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Pharynx Foreign Body","PX-4902166","CDM",42809,"CPT",450,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tonsillectomy/Adenoidect<12yrs","PX-4902172","CDM",42820,"CPT",360,"RC",{"$nulls":6},"both",null,null,16739.13,16739.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tonsillectomy/Adenoidect>12yrs","PX-4902174","CDM",42821,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Adenoids Primary <12yrs","PX-4902180","CDM",42830,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excision of Anal Lesion(S)","PX-4902193","CDM",46922,"CPT",761,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Laparoscopic Cholecystectomy","PX-4902216","CDM",47562,"CPT",360,"RC",{"$nulls":6},"both",null,null,16492.77,16492.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cvc Plmt >5 Years Old","PX-4901250","CDM",36556,"CPT",450,"RC",{"$nulls":6},"both",null,null,9111.03,9111.03,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Tunnel Cv Access Device, W Port/Pump","PX-4901265","CDM",36590,"CPT",360,"RC",{"$nulls":6},"both",null,null,4577.79,4577.79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Declot Vascular Device","PX-4901268","CDM",36593,"CPT",761,"RC",{"$nulls":6},"both",null,null,968.04,968.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rpr Initial Hernia >5 Yrs Reduc","PX-4902263","CDM",49505,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rpr Inguinal Hernia,Reduce","PX-4902265","CDM",49520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rpr Inguinal Hernia,Blocked","PX-4902266","CDM",49521,"CPT",360,"RC",{"$nulls":6},"both",null,null,21625.23,21625.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rpr Init Femoral Hernia,Reduce","PX-4902267","CDM",49550,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion","PX-10021","CDM",10021,"CPT",982,"RC",{"$nulls":6},"both",null,null,290.13,290.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},51.16,97.33,null,null,"facility"]
["HC Laparo Hernia Repair Initial","PX-4902281","CDM",49650,"CPT",360,"RC",{"$nulls":6},"both",null,null,16492.77,16492.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Laparoscopy Inguinal Hernia","PX-4902282","CDM",49651,"CPT",360,"RC",{"$nulls":6},"both",null,null,16492.77,16492.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bone Marrow Aspiration","PX-4901318","CDM",38220,"CPT",450,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bone Marrow Biopsy","PX-4901319","CDM",38221,"CPT",450,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Incision & Drainage Abscess Simple/Single","PX-10060","CDM",10060,"CPT",982,"RC",{"$nulls":6},"both",null,null,368.34,368.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},103.38,123.35,null,null,"facility"]
["Incision & Drainage Abscess Complicated/Multiple","PX-10061","CDM",10061,"CPT",981,"RC",{"$nulls":6},"both",null,null,751.14,751.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},177,206.79,null,null,"facility"]
["Incision & Drainage Pilonidal Cyst Simple","PX-10080","CDM",10080,"CPT",982,"RC",{"$nulls":6},"both",null,null,728.52,728.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},100.96,243.73,null,null,"facility"]
["Incision & Removal Foreign Body Subq Tiss Simple","PX-10120","CDM",10120,"CPT",982,"RC",{"$nulls":6},"both",null,null,441.78,441.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},102.08,147.92,null,null,"facility"]
["HC Change of Bladder Tube Smpl","PX-4901351","CDM",51705,"CPT",360,"RC",{"$nulls":6},"both",null,null,729.63,729.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Incision & Removal Foreign Body Subq Tiss Comp","PX-10121","CDM",10121,"CPT",982,"RC",{"$nulls":6},"both",null,null,758.64,758.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},174.42,254.65,null,null,"facility"]
["I&D Hematoma Seroma/Fluid Collection","PX-10140","CDM",10140,"CPT",982,"RC",{"$nulls":6},"both",null,null,490.2,490.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},113.58,164.33,null,null,"facility"]
["HC Cystourethroscopy","PX-4901365","CDM",52000,"CPT",761,"RC",{"$nulls":6},"both",null,null,1952.58,1952.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Puncture Aspiration Abscess Hematoma Bulla/Cyst","PX-10160","CDM",10160,"CPT",982,"RC",{"$nulls":6},"both",null,null,374.37,374.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},92.76,125.5,null,null,"facility"]
["Dbrdmt Extensv Eczmt/Infct Skin Up 10% Bdy Surf","PX-11000","CDM",11000,"CPT",982,"RC",{"$nulls":6},"both",null,null,171.81,171.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},26.06,57.49,null,null,"facility"]
["HC Slitting of Prepuce","PX-4901434","CDM",54001,"CPT",761,"RC",{"$nulls":6},"both",null,null,5821.98,5821.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Circumcision 28 Days or Older","PX-4901445","CDM",54161,"CPT",360,"RC",{"$nulls":6},"both",null,null,5821.98,5821.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Debridement Subcutaneous Tissue 1st 20 Sq Cm/<","PX-11042","CDM",11042,"CPT",982,"RC",{"$nulls":6},"both",null,null,375.21,375.21,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},57.21,125.65,null,null,"facility"]
["HC Removal of Testis Smpl","PX-4901466","CDM",54520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9964.74,9964.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Debridement Muscle &/Fascia 1st 20 Sq Cm/<","PX-11043","CDM",11043,"CPT",982,"RC",{"$nulls":6},"both",null,null,662.37,662.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},143.64,222.56,null,null,"facility"]
["HC Remove Hydrocele","PX-4901481","CDM",55040,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Nerve Block Inj,Axillary","PX-4903146","CDM",64417,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Sperm Duct(S)","PX-4901489","CDM",55250,"CPT",360,"RC",{"$nulls":6},"both",null,null,5821.8,5821.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Paring/Cutting Benign Hyperkeratotic Lesion 1","PX-11055","CDM",11055,"CPT",982,"RC",{"$nulls":6},"both",null,null,208.41,208.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},14.59,69.6,null,null,"facility"]
["HC Drain Gland Abscess","PX-4901504","CDM",56420,"CPT",360,"RC",{"$nulls":6},"both",null,null,569.58,569.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgery for Vulvar Lesion","PX-4901505","CDM",56440,"CPT",360,"RC",{"$nulls":6},"both",null,null,8936.31,8936.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Vaginal Gland Lesion","PX-4901514","CDM",56740,"CPT",761,"RC",{"$nulls":6},"both",null,null,8936.31,8936.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Rmvl Skin Tags Mlt Fibrq Tags Any Up to&Inc 15","PX-11200","CDM",11200,"CPT",982,"RC",{"$nulls":6},"both",null,null,268.62,268.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},74.22,89.93,null,null,"facility"]
["HC Biopsy of Cervix","PX-4901549","CDM",57500,"CPT",761,"RC",{"$nulls":6},"both",null,null,2297.88,2297.88,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Rmvl Skin Tags Mlt Fibrq Tags Any Ea Addl 10","PX-11201","CDM",11201,"CPT",982,"RC",{"$nulls":6},"both",null,null,52.2,52.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},15.24,17.53,null,null,"facility"]
["HC Biopsy of Uterus Lining","PX-4901558","CDM",58100,"CPT",761,"RC",{"$nulls":6},"both",null,null,569.58,569.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Dilation & Curettage","PX-4901560","CDM",58120,"CPT",360,"RC",{"$nulls":6},"both",null,null,8936.31,8936.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Insert Intrauterine Device","PX-4901562","CDM",58300,"CPT",360,"RC",{"$nulls":6},"both",null,null,1583.69,1583.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Intrauterine Device(Iud","PX-4901563","CDM",58301,"CPT",360,"RC",{"$nulls":6},"both",null,null,916.98,916.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Shaving Skin Lesion 1 Trunk/Arm/Leg Diam 0.5cm/<","PX-11300","CDM",11300,"CPT",982,"RC",{"$nulls":6},"both",null,null,292.41,292.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},31.96,97.78,null,null,"facility"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm","PX-11301","CDM",11301,"CPT",982,"RC",{"$nulls":6},"both",null,null,352.47,352.47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},48.19,117.93,null,null,"facility"]
["Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm","PX-11302","CDM",11302,"CPT",982,"RC",{"$nulls":6},"both",null,null,398.04,398.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},56.22,133.17,null,null,"facility"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm","PX-11303","CDM",11303,"CPT",982,"RC",{"$nulls":6},"both",null,null,439.44,439.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},66.88,147.1,null,null,"facility"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/<","PX-11305","CDM",11305,"CPT",982,"RC",{"$nulls":6},"both",null,null,306.18,306.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},35.24,102.36,null,null,"facility"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm","PX-11306","CDM",11306,"CPT",982,"RC",{"$nulls":6},"both",null,null,356.04,356.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},46.06,119.08,null,null,"facility"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm","PX-11307","CDM",11307,"CPT",982,"RC",{"$nulls":6},"both",null,null,401.37,401.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},58.68,134.32,null,null,"facility"]
["Spinal Puncture","PX-4901628","CDM",62270,"CPT",450,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Spinal Puncture,Therapeutic","PX-4901629","CDM",62272,"CPT",450,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm","PX-11308","CDM",11308,"CPT",982,"RC",{"$nulls":6},"both",null,null,422.37,422.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},65.72,141.36,null,null,"facility"]
["Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/<","PX-11310","CDM",11310,"CPT",982,"RC",{"$nulls":6},"both",null,null,336.39,336.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},42.78,112.53,null,null,"facility"]
["Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm","PX-11311","CDM",11311,"CPT",982,"RC",{"$nulls":6},"both",null,null,396.45,396.45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},59.01,132.68,null,null,"facility"]
["HC Trigeminal Nerve Block","PX-4901661","CDM",64400,"CPT",360,"RC",{"$nulls":6},"both",null,null,3087,3087,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Occipital Nerve Block","PX-4901662","CDM",64405,"CPT",761,"RC",{"$nulls":6},"both",null,null,3087,3087,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Shvg Skin Lesion 1 F/E/E/N/L/M Diam 1.1-2.0 Cm","PX-11312","CDM",11312,"CPT",982,"RC",{"$nulls":6},"both",null,null,450.24,450.24,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},69.82,150.7,null,null,"facility"]
["HC Suprascapular Nerve Block","PX-4901667","CDM",64418,"CPT",761,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Intercostal Nerve Block,Sng","PX-4901668","CDM",64420,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Intercostal Nerve Block,Mlt","PX-4901669","CDM",64421,"CPT",360,"RC",{"$nulls":6},"both",null,null,2670.87,2670.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pudendal Nerve Block","PX-4901670","CDM",64430,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Sciatic Nerve","PX-4901671","CDM",64445,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Peripheral Nerve Block","PX-4901673","CDM",64450,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Shaving Skin Lesion 1 F/E/E/N/L/M Diam >2.0 Cm","PX-11313","CDM",11313,"CPT",982,"RC",{"$nulls":6},"both",null,null,522.84,522.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},90.32,175.12,null,null,"facility"]
["HC Plantar Nerve Block","PX-4901674","CDM",64455,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Foramen Epidural L/S","PX-4901680","CDM",64483,"CPT",360,"RC",{"$nulls":6},"both",null,null,2670.87,2670.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Inj Foramen Epidural Addon","PX-4901681","CDM",64484,"CPT",360,"RC",{"$nulls":6},"both",null,null,1435.02,1435.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Spenopalatine Gangl Nerve Block","PX-4901682","CDM",64505,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.5 Cm/<","PX-11400","CDM",11400,"CPT",982,"RC",{"$nulls":6},"both",null,null,372.87,372.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},81.6,124.82,null,null,"facility"]
["HC Stellate Ganglion Nerve Block","PX-4901683","CDM",64510,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Lumbar Sympathetic Nerve Block","PX-4901684","CDM",64520,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Celiac Plexus Nerve Block","PX-4901685","CDM",64530,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm","PX-11401","CDM",11401,"CPT",982,"RC",{"$nulls":6},"both",null,null,452.97,452.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},101.92,151.69,null,null,"facility"]
["HC Out of Room Procedure","PX-7620020","CDM",null,null,9999,"RC",{"$nulls":6},"both",null,null,3000,3000,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destroy Nerve Face Muscle","PX-4901693","CDM",64612,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC in Room Procedure","PX-7620021","CDM",null,null,9999,"RC",{"$nulls":6},"both",null,null,2250,2250,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cryoablation","PX-4901701","CDM",64640,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 1.1-2.0 Cm","PX-11402","CDM",11402,"CPT",982,"RC",{"$nulls":6},"both",null,null,498.3,498.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},111.27,166.94,null,null,"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 2.1-3.0 Cm","PX-11403","CDM",11403,"CPT",982,"RC",{"$nulls":6},"both",null,null,571.05,571.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},143.73,191.54,null,null,"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 3.1-4.0 Cm","PX-11404","CDM",11404,"CPT",982,"RC",{"$nulls":6},"both",null,null,643.8,643.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},157.2,216.14,null,null,"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L >4.0 Cm","PX-11406","CDM",11406,"CPT",982,"RC",{"$nulls":6},"both",null,null,905.91,905.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},234.82,304.89,null,null,"facility"]
["Remove FB-Eye","PX-4901735","CDM",65205,"CPT",450,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove FB From Eye Embed Conjunc","PX-4901736","CDM",65210,"CPT",450,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Remove FB-Eye","PX-4901737","CDM",65220,"CPT",450,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 0.5 Cm/<","PX-11420","CDM",11420,"CPT",982,"RC",{"$nulls":6},"both",null,null,369.18,369.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},79.62,123.5,null,null,"facility"]
["HC Excis Pterygium","PX-4901747","CDM",65420,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excis Pterygium,W Graft","PX-4901748","CDM",65426,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 0.6-1.0cm","PX-11421","CDM",11421,"CPT",982,"RC",{"$nulls":6},"both",null,null,463.17,463.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},105.04,155.14,null,null,"facility"]
["HC Incise Inner Eye Adhesns,Incisn","PX-4901759","CDM",65865,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 1.1-2.0cm","PX-11422","CDM",11422,"CPT",982,"RC",{"$nulls":6},"both",null,null,518.7,518.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},130.93,173.82,null,null,"facility"]
["HC Glaucoma Surg,Trabecu Ab Externo","PX-4901766","CDM",66170,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Followup Surgery of Eye","PX-4901769","CDM",66250,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Iris","PX-4901771","CDM",66625,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 2.1-3.0cm","PX-11423","CDM",11423,"CPT",982,"RC",{"$nulls":6},"both",null,null,592.65,592.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},150.94,198.74,null,null,"facility"]
["Yag Laser","PX-4901775","CDM",66821,"CPT",360,"RC",{"$nulls":6},"both",null,null,1661.49,1661.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Reposition Intraocular Lens","PX-4901776","CDM",66825,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 3.1-4.0cm","PX-11424","CDM",11424,"CPT",982,"RC",{"$nulls":6},"both",null,null,682.86,682.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},172.93,229.25,null,null,"facility"]
["HC Cataract Surg W Iol,1 Stage","PX-4901783","CDM",66984,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Part Removal Eye Fluid Ant Approach","PX-4901787","CDM",67005,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Part Removal Eye Fluid Mech Virectomy","PX-4901788","CDM",67010,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G > 4.0cm","PX-11426","CDM",11426,"CPT",982,"RC",{"$nulls":6},"both",null,null,933.27,933.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},253.95,313.88,null,null,"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M 0.5cm/<","PX-11440","CDM",11440,"CPT",982,"RC",{"$nulls":6},"both",null,null,418.68,418.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},104.35,140.04,null,null,"facility"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 0.6-1.0cm","PX-11441","CDM",11441,"CPT",982,"RC",{"$nulls":6},"both",null,null,504.57,504.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},128.8,169.07,null,null,"facility"]
["Drain Eyelid","PX-4901815","CDM",67700,"CPT",450,"RC",{"$nulls":6},"both",null,null,832.68,832.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excis Chalazion,Single","PX-4901818","CDM",67800,"CPT",360,"RC",{"$nulls":6},"both",null,null,832.68,832.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 1.1-2.0cm","PX-11442","CDM",11442,"CPT",982,"RC",{"$nulls":6},"both",null,null,559.11,559.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},141.59,187.43,null,null,"facility"]
["HC Fix Lid Ptosis,Levatr Resec,Intern","PX-4901831","CDM",67903,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Fix Lid Ptosis,Levatr Resec,Extern","PX-4901832","CDM",67904,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 2.1-3.0cm","PX-11443","CDM",11443,"CPT",982,"RC",{"$nulls":6},"both",null,null,656.4,656.4,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},171.76,220.22,null,null,"facility"]
["HC Fix Ectropion,Suture","PX-4901837","CDM",67914,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Fix Ectropion,Entensv Lid Repair","PX-4901839","CDM",67917,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Fix Entropion Sutre","PX-4901840","CDM",67921,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 3.1-4.0cm","PX-11444","CDM",11444,"CPT",982,"RC",{"$nulls":6},"both",null,null,812.19,812.19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},215.37,272.68,null,null,"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M > 4.0cm","PX-11446","CDM",11446,"CPT",982,"RC",{"$nulls":6},"both",null,null,1095.27,1095.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},301.3,368.1,null,null,"facility"]
["Remove Ear Wax","PX-4901882","CDM",69210,"CPT",450,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Incise Eardrum,Aspir,Gen Anesth","PX-4901890","CDM",69421,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Ventilating Tube Other MD","PX-4901891","CDM",69424,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Create Eardrum Opening Local Anesth","PX-4901892","CDM",69433,"CPT",360,"RC",{"$nulls":6},"both",null,null,1572.69,1572.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Create Eardrum Opening Gen Anesth","PX-4901893","CDM",69436,"CPT",360,"RC",{"$nulls":6},"both",null,null,4359.15,4359.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/<","PX-11600","CDM",11600,"CPT",982,"RC",{"$nulls":6},"both",null,null,571.14,571.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},117.02,191.35,null,null,"facility"]
["Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm","PX-11601","CDM",11601,"CPT",982,"RC",{"$nulls":6},"both",null,null,661.65,661.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},141.76,221.65,null,null,"facility"]
["Excision Mal Lesion Trunk/Arm/Leg 1.1-2.0 Cm","PX-11602","CDM",11602,"CPT",982,"RC",{"$nulls":6},"both",null,null,708.81,708.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},154.2,237.37,null,null,"facility"]
["Colonoscopy","PX-4901948","CDM","G0105","HCPCS",360,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colonscopy","PX-4901949","CDM","G0121","HCPCS",360,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm","PX-11603","CDM",11603,"CPT",982,"RC",{"$nulls":6},"both",null,null,803.52,803.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},183.56,269.35,null,null,"facility"]
["Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm","PX-11604","CDM",11604,"CPT",982,"RC",{"$nulls":6},"both",null,null,892.98,892.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},201.28,299.52,null,null,"facility"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",982,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},296,427.96,null,null,"facility"]
["Excision Malignant Lesion S/N/H/F/G 0.5 Cm/<","PX-11620","CDM",11620,"CPT",982,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},117.84,192.17,null,null,"facility"]
["HC Laryngeal Function Study","PX-5100017","CDM",92520,"CPT",510,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Allergen Immun;Single Injectio","PX-5100022","CDM",95115,"CPT",940,"RC",{"$nulls":6},"both",null,null,135.78,135.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Allergen Immun;2 or More Injec","PX-5100023","CDM",95117,"CPT",940,"RC",{"$nulls":6},"both",null,null,135.78,135.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion S/N/H/F/G 0.6-1.0 Cm","PX-11621","CDM",11621,"CPT",982,"RC",{"$nulls":6},"both",null,null,666,666,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},142.25,222.15,null,null,"facility"]
["HC Glucose Monitoring,Continuous","PX-5100029","CDM",95250,"CPT",761,"RC",{"$nulls":6},"both",null,null,377.85,377.85,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion S/N/H/F/G 1.1-2.0 Cm","PX-11622","CDM",11622,"CPT",982,"RC",{"$nulls":6},"both",null,null,731.91,731.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},161.43,245.25,null,null,"facility"]
["Excision Malignant Lesion S/N/H/F/G 2.1-3.0 Cm","PX-11623","CDM",11623,"CPT",982,"RC",{"$nulls":6},"both",null,null,850.98,850.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},198.33,285.42,null,null,"facility"]
["Excision Malignant Lesion S/N/H/F/G 3.1-4.0 Cm","PX-11624","CDM",11624,"CPT",982,"RC",{"$nulls":6},"both",null,null,965.49,965.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},224.59,324.13,null,null,"facility"]
["Excision Malignant Lesion S/N/H/F/G >4.0 Cm","PX-11626","CDM",11626,"CPT",982,"RC",{"$nulls":6},"both",null,null,1152.69,1152.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},272.37,387.63,null,null,"facility"]
["HC Mileage","PX-5420001","CDM","A0425","HCPCS",540,"RC",{"$nulls":6},"both",null,null,27.06,27.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Als 1 ER","PX-5420002","CDM","A0427","HCPCS",540,"RC",{"$nulls":6},"both",null,null,1599.51,1599.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Bls,ER","PX-5420003","CDM","A0429","HCPCS",540,"RC",{"$nulls":6},"both",null,null,1346.94,1346.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Als 2","PX-5420005","CDM","A0433","HCPCS",540,"RC",{"$nulls":6},"both",null,null,2315.07,2315.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Special Care Transport","PX-5420006","CDM","A0434","HCPCS",540,"RC",{"$nulls":6},"both",null,null,2735.97,2735.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L 0.5 Cm/<","PX-11640","CDM",11640,"CPT",982,"RC",{"$nulls":6},"both",null,null,589.41,589.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},121.43,197.4,null,null,"facility"]
["MRI-Eye/Face/Neck","PX-6100000","CDM",70540,"CPT",610,"RC",{"$nulls":6},"both",null,null,2500,2500,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Orbit/Face/Neck","PX-6100001","CDM",70542,"CPT",320,"RC",{"$nulls":6},"both",null,null,2458,2458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Eye/Face/Neck","PX-6100002","CDM",70543,"CPT",610,"RC",{"$nulls":6},"both",null,null,3150,3150,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Mra-Head","PX-6100003","CDM",70544,"CPT",611,"RC",{"$nulls":6},"both",null,null,1564.5,1564.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Mra Head W/WO Dye","PX-6100005","CDM",70546,"CPT",610,"RC",{"$nulls":6},"both",null,null,2458,2458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Mra-Neck","PX-6100006","CDM",70547,"CPT",610,"RC",{"$nulls":6},"both",null,null,3400,3400,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Mra-Neck","PX-6100008","CDM",70549,"CPT",612,"RC",{"$nulls":6},"both",null,null,2458,2458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L 0.6-1.0 Cm","PX-11641","CDM",11641,"CPT",982,"RC",{"$nulls":6},"both",null,null,684.99,684.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},148.32,229.52,null,null,"facility"]
["MRI-Chest","PX-6100009","CDM",71550,"CPT",610,"RC",{"$nulls":6},"both",null,null,1564.5,1564.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Chest WO/W Dye","PX-6100011","CDM",71552,"CPT",610,"RC",{"$nulls":6},"both",null,null,4920,4920,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Pelvis","PX-6100013","CDM",72195,"CPT",610,"RC",{"$nulls":6},"both",null,null,3070,3070,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Pelvis","PX-6100015","CDM",72197,"CPT",610,"RC",{"$nulls":6},"both",null,null,3990,3990,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Upper Ext W/O Dye","PX-6100017","CDM",73218,"CPT",612,"RC",{"$nulls":6},"both",null,null,1564.5,1564.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L 1.1-2.0 Cm","PX-11642","CDM",11642,"CPT",982,"RC",{"$nulls":6},"both",null,null,773.07,773.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},173.08,259.2,null,null,"facility"]
["MRI-Upper Extremity","PX-6100019","CDM",73220,"CPT",610,"RC",{"$nulls":6},"both",null,null,4210,4210,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-Upper Extremity","PX-6100020","CDM",73221,"CPT",610,"RC",{"$nulls":6},"both",null,null,1720,1720,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Upper Ext Joint W/WO Dye","PX-6100022","CDM",73223,"CPT",610,"RC",{"$nulls":6},"both",null,null,3680,3680,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Lower Extremity","PX-6100024","CDM",73718,"CPT",610,"RC",{"$nulls":6},"both",null,null,3020,3020,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Lower Extremity","PX-6100026","CDM",73720,"CPT",610,"RC",{"$nulls":6},"both",null,null,4200,4200,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Lower Extremity","PX-6100027","CDM",73721,"CPT",610,"RC",{"$nulls":6},"both",null,null,1700,1700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L 2.1-3.0 Cm","PX-11643","CDM",11643,"CPT",982,"RC",{"$nulls":6},"both",null,null,903.33,903.33,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},215.06,303.14,null,null,"facility"]
["Lower Ext Joint W/WO Dye","PX-6100029","CDM",73723,"CPT",610,"RC",{"$nulls":6},"both",null,null,3700,3700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-Abdomen","PX-6100031","CDM",74181,"CPT",610,"RC",{"$nulls":6},"both",null,null,2640,2640,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI Abdomen","PX-6100033","CDM",74183,"CPT",610,"RC",{"$nulls":6},"both",null,null,4200,4200,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Mra Abdomen","PX-6100034","CDM",74185,"CPT",610,"RC",{"$nulls":6},"both",null,null,6975.94,6975.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L 3.1-4.0 Cm","PX-11644","CDM",11644,"CPT",982,"RC",{"$nulls":6},"both",null,null,1111.68,1111.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},265.57,373.3,null,null,"facility"]
["MRI-Tmj","PX-6110000","CDM",70336,"CPT",611,"RC",{"$nulls":6},"both",null,null,2700,2700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-Brain/Brain Stem","PX-6110001","CDM",70551,"CPT",611,"RC",{"$nulls":6},"both",null,null,1590,1590,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L >4.0 Cm","PX-11646","CDM",11646,"CPT",982,"RC",{"$nulls":6},"both",null,null,1430.1,1430.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},364.5,481.07,null,null,"facility"]
["MRI-Brain","PX-6110002","CDM",70552,"CPT",611,"RC",{"$nulls":6},"both",null,null,2350,2350,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-Brain","PX-6110003","CDM",70553,"CPT",611,"RC",{"$nulls":6},"both",null,null,2670,2670,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-C-Spine","PX-6120000","CDM",72141,"CPT",612,"RC",{"$nulls":6},"both",null,null,1530,1530,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-T-Spine","PX-6120002","CDM",72146,"CPT",612,"RC",{"$nulls":6},"both",null,null,1530,1530,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-L-Spine","PX-6120004","CDM",72148,"CPT",612,"RC",{"$nulls":6},"both",null,null,1500,1500,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-Lumbar Spine","PX-6120005","CDM",72149,"CPT",612,"RC",{"$nulls":6},"both",null,null,2458,2458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["MRI-C-Spine","PX-6120006","CDM",72156,"CPT",612,"RC",{"$nulls":6},"both",null,null,2700,2700,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["T-Spine","PX-6120007","CDM",72157,"CPT",612,"RC",{"$nulls":6},"both",null,null,2703,2703,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Trimming Nondystrophic Nails Any Number","PX-11719","CDM",11719,"CPT",982,"RC",{"$nulls":6},"both",null,null,41.64,41.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},7.05,13.92,null,null,"facility"]
["L-Spine","PX-6120008","CDM",72158,"CPT",612,"RC",{"$nulls":6},"both",null,null,2810,2810,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Pacu/IP Min","PX-7100001","CDM",null,null,710,"RC",{"$nulls":6},"both",null,null,1800,1800,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Avulsion Nail Plate Partial/Complete Simple 1","PX-11730","CDM",11730,"CPT",982,"RC",{"$nulls":6},"both",null,null,334.41,334.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},50.97,111.87,null,null,"facility"]
["HC Vaginal Delivery","PX-7220000","CDM",59409,"CPT",450,"RC",{"$nulls":6},"both",null,null,8936.31,8936.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["EKG","PX-7300000","CDM",93005,"CPT",730,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ecg,Tracing","PX-7300002","CDM",93041,"CPT",730,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Ecg Monitor/Record Up to 48 Hrs","PX-7310000","CDM",93225,"CPT",731,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Avulsion Nail Plate Partial/Comp Simple Ea Addl","PX-11732","CDM",11732,"CPT",982,"RC",{"$nulls":6},"both",null,null,95.43,95.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},15.9,31.94,null,null,"facility"]
["HC Scanning Analysis W/Report","PX-7310001","CDM",93226,"CPT",731,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["EEG","PX-7400003","CDM",95819,"CPT",740,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Evacuation Subungual Hematoma","PX-11740","CDM",11740,"CPT",982,"RC",{"$nulls":6},"both",null,null,169.11,169.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},31.29,56.5,null,null,"facility"]
["HC Upper GI Endoscopy,Dx","PX-7500000","CDM",43235,"CPT",360,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Upper GI Endoscopy,Biopsy","PX-7500001","CDM",43239,"CPT",360,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Upper GI-Inj Sclerosis Eso/Gas","PX-7500002","CDM",43243,"CPT",750,"RC",{"$nulls":6},"both",null,null,5438.97,5438.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Upper GI Scope Dilate Stricture","PX-7500004","CDM",43245,"CPT",750,"RC",{"$nulls":6},"both",null,null,5438.97,5438.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Nail Matrix Permanent Removal","PX-11750","CDM",11750,"CPT",982,"RC",{"$nulls":6},"both",null,null,467.55,467.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},98.14,156.43,null,null,"facility"]
["Upper GI","PX-7500006","CDM",43247,"CPT",750,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Upper GI Balloon Dilation","PX-7500007","CDM",43249,"CPT",750,"RC",{"$nulls":6},"both",null,null,5438.97,5438.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Up GI Endoscopy,Remv Tumor,Snare","PX-7500009","CDM",43251,"CPT",750,"RC",{"$nulls":6},"both",null,null,5438.97,5438.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500031","CDM",45378,"CPT",360,"RC",{"$nulls":6},"both",null,null,2558.88,2558.88,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500033","CDM",45380,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Repair Nail Bed","PX-11760","CDM",11760,"CPT",982,"RC",{"$nulls":6},"both",null,null,534.63,534.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},104.72,179.05,null,null,"facility"]
["HC Colonoscopy,Submucous Inj","PX-7500034","CDM",45381,"CPT",750,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500036","CDM",45384,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500037","CDM",45385,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Colonoscopy Dilate Stricture","PX-7500038","CDM",45386,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Office Visit-Est Patient Level II","PX-7610006","CDM",99212,"CPT",510,"RC",{"$nulls":6},"both",null,null,377.85,377.85,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Wedge Excision Skin Nail Fold","PX-11765","CDM",11765,"CPT",982,"RC",{"$nulls":6},"both",null,null,485.1,485.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},90.1,162.14,null,null,"facility"]
["Hourly Observation","PX-7620000","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,940,940,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Icu Hourly Obs","PX-7620005","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,1387,1387,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Pilonidal Cyst/Sinus Simple","PX-11770","CDM",11770,"CPT",982,"RC",{"$nulls":6},"both",null,null,1011.72,1011.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},173.88,339.89,null,null,"facility"]
["Immunization Administration","PX-7710000","CDM",90471,"CPT",771,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Immunization Admin Ea Addl","PX-7710001","CDM",90472,"CPT",940,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Gastric Intubat Dx W/Aspiration Single Specimen","PX-43754","CDM",43754,"CPT",975,"RC",{"$nulls":6},"both",null,null,684.51,684.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},35.75,228.61,null,null,"facility"]
["Excision Pilonidal Cyst/Sinus Extensive","PX-11771","CDM",11771,"CPT",982,"RC",{"$nulls":6},"both",null,null,1781.43,1781.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},423.83,600,null,null,"facility"]
["Excision Pilonidal Cyst/Sinus Complicated","PX-11772","CDM",11772,"CPT",982,"RC",{"$nulls":6},"both",null,null,2185.11,2185.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},547.1,735.7,null,null,"facility"]
["Injection Intralesional Up to & Includ 7 Lesions","PX-11900","CDM",11900,"CPT",982,"RC",{"$nulls":6},"both",null,null,166.29,166.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},28.19,55.7,null,null,"facility"]
["HC Sleep Study Attended","PX-9200035","CDM",95807,"CPT",920,"RC",{"$nulls":6},"both",null,null,1591.8,1591.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Sleep Study","PX-9200036","CDM",95810,"CPT",920,"RC",{"$nulls":6},"both",null,null,3052.17,3052.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Sleep Study","PX-9200037","CDM",95811,"CPT",920,"RC",{"$nulls":6},"both",null,null,3052.17,3052.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Carotid Doppler","PX-9210009","CDM",93880,"CPT",921,"RC",{"$nulls":6},"both",null,null,725.16,725.16,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Carotid Unilat/Ltd Doppler","PX-9210010","CDM",93882,"CPT",921,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Duplex Lower Extremity","PX-9210016","CDM",93925,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Duplex Lower Ext Follow Up","PX-9210017","CDM",93926,"CPT",921,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Duplex Upper Extremity","PX-9210018","CDM",93930,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Venous Imaging","PX-9210020","CDM",93970,"CPT",921,"RC",{"$nulls":6},"both",null,null,725.16,725.16,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Scan Extremity Veins","PX-9210021","CDM",93971,"CPT",921,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Duplex Arterial Flow","PX-9210022","CDM",93975,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Duplex Abd Organ Follow Up","PX-9210023","CDM",93976,"CPT",921,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Duplex Abd Vasculature","PX-9210024","CDM",93978,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Hydration,Initial","PX-9400003","CDM",96360,"CPT",260,"RC",{"$nulls":6},"both",null,null,632.07,632.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Hydration Ea Addl Hr","PX-9400004","CDM",96361,"CPT",260,"RC",{"$nulls":6},"both",null,null,138.42,138.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Infusion,Initial","PX-9400005","CDM",96365,"CPT",260,"RC",{"$nulls":6},"both",null,null,632.07,632.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Infusion Ea Addl Hr","PX-9400006","CDM",96366,"CPT",260,"RC",{"$nulls":6},"both",null,null,138.42,138.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Infusion Addl","PX-9400007","CDM",96367,"CPT",260,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Infusion","PX-9400008","CDM",96368,"CPT",260,"RC",{"$nulls":6},"both",null,null,612.66,612.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Injection","PX-9400009","CDM",96372,"CPT",260,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["IV Push","PX-9400011","CDM",96374,"CPT",260,"RC",{"$nulls":6},"both",null,null,632.07,632.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["IV Push","PX-9400012","CDM",96375,"CPT",260,"RC",{"$nulls":6},"both",null,null,138.42,138.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["IV Push","PX-9400013","CDM",96376,"CPT",260,"RC",{"$nulls":6},"both",null,null,135.78,135.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Port Flush","PX-9400017","CDM",96523,"CPT",761,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Phlebotomy","PX-9400021","CDM",99195,"CPT",940,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Removal Implantable Contraceptive Capsules","PX-11976","CDM",11976,"CPT",982,"RC",{"$nulls":6},"both",null,null,411.06,411.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},85.96,138.35,null,null,"facility"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora","PX-64633","CDM",64633,"CPT",975,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},182.89,425.53,null,null,"facility"]
["Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora","PX-64634","CDM",64634,"CPT",975,"RC",{"$nulls":6},"both",null,null,745.56,745.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},63.1,249.09,null,null,"facility"]
["HC Diabetes Train/Indiv 30 Min","PX-9420004","CDM","G0108","HCPCS",942,"RC",{"$nulls":6},"both",null,null,158.22,158.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Diabetes Education","PX-9420005","CDM","G0109","HCPCS",942,"RC",{"$nulls":6},"both",null,null,45.69,45.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cardiac Rehab/Phase I Non-Monitored","PX-9430000","CDM",93797,"CPT",943,"RC",{"$nulls":6},"both",null,null,377.7,377.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Card Rehab Phase II","PX-9430001","CDM",93798,"CPT",943,"RC",{"$nulls":6},"both",null,null,377.7,377.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral","PX-64635","CDM",64635,"CPT",975,"RC",{"$nulls":6},"both",null,null,1283.13,1283.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},183.22,429.13,null,null,"facility"]
["Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral","PX-64636","CDM",64636,"CPT",975,"RC",{"$nulls":6},"both",null,null,700.59,700.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.24,234.02,null,null,"facility"]
["Insertion Drug Delivery Implant","PX-11981","CDM",11981,"CPT",982,"RC",{"$nulls":6},"both",null,null,284.91,284.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},57.91,95.89,null,null,"facility"]
["Removal Non-Biodegradable Drug Delivery Implant","PX-11982","CDM",11982,"CPT",982,"RC",{"$nulls":6},"both",null,null,313.53,313.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},67.59,105.57,null,null,"facility"]
["Rmvl W/Rinsj Non-Biodegradable Drug Dlvr Implt","PX-11983","CDM",11983,"CPT",982,"RC",{"$nulls":6},"both",null,null,398.82,398.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},95.47,134.44,null,null,"facility"]
["Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<","PX-12001","CDM",12001,"CPT",982,"RC",{"$nulls":6},"both",null,null,269.28,269.28,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},41.35,90.46,null,null,"facility"]
["Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm","PX-12002","CDM",12002,"CPT",982,"RC",{"$nulls":6},"both",null,null,324.57,324.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},54.15,109.16,null,null,"facility"]
["Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm","PX-12004","CDM",12004,"CPT",982,"RC",{"$nulls":6},"both",null,null,376.32,376.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},67.45,126.72,null,null,"facility"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 12.6-20.0cm","PX-12005","CDM",12005,"CPT",982,"RC",{"$nulls":6},"both",null,null,500.28,500.28,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},86.34,168.53,null,null,"facility"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 20.1-30.0cm","PX-12006","CDM",12006,"CPT",982,"RC",{"$nulls":6},"both",null,null,576.57,576.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},105.86,194.27,null,null,"facility"]
["Simple Repair F/E/E/N/L/M 2.5cm/<","PX-12011","CDM",12011,"CPT",982,"RC",{"$nulls":6},"both",null,null,319.29,319.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},51.03,107.35,null,null,"facility"]
["Simple Repair F/E/E/N/L/M 2.6cm-5.0 Cm","PX-12013","CDM",12013,"CPT",982,"RC",{"$nulls":6},"both",null,null,331.2,331.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.85,111.46,null,null,"facility"]
["Simple Repair F/E/E/N/L/M 5.1cm-7.5 Cm","PX-12014","CDM",12014,"CPT",982,"RC",{"$nulls":6},"both",null,null,402.96,402.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},68.29,135.74,null,null,"facility"]
["Simple Repair F/E/E/N/L/M 7.6cm-12.5 Cm","PX-12015","CDM",12015,"CPT",982,"RC",{"$nulls":6},"both",null,null,485.55,485.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},85.69,163.62,null,null,"facility"]
["Tx Superficial Wound Dehiscence Simple Closure","PX-12020","CDM",12020,"CPT",982,"RC",{"$nulls":6},"both",null,null,861.54,861.54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},178.69,289.04,null,null,"facility"]
["Repair Intermediate S/a/T/E 2.5 Cm/<","PX-12031","CDM",12031,"CPT",982,"RC",{"$nulls":6},"both",null,null,761.85,761.85,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},144.7,255.05,null,null,"facility"]
["Repair Intermediate S/a/T/E 2.6-7.5 Cm","PX-12032","CDM",12032,"CPT",982,"RC",{"$nulls":6},"both",null,null,880.23,880.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},182.06,294.7,null,null,"facility"]
["Repair Intermediate S/a/T/E 7.6-12.5 Cm","PX-12034","CDM",12034,"CPT",982,"RC",{"$nulls":6},"both",null,null,964.92,964.92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},195.05,323.41,null,null,"facility"]
["Repair Intermediate S/a/T/E 12.6-20.0cm","PX-12035","CDM",12035,"CPT",982,"RC",{"$nulls":6},"both",null,null,1112.07,1112.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},227.1,373.47,null,null,"facility"]
["Repair Intermediate S/a/T/E 20.1-30.0 Cm","PX-12036","CDM",12036,"CPT",982,"RC",{"$nulls":6},"both",null,null,1228.5,1228.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},263.43,413.39,null,null,"facility"]
["Repair Intermediate S/a/T/E >30.0 Cm","PX-12037","CDM",12037,"CPT",982,"RC",{"$nulls":6},"both",null,null,1375.74,1375.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},305.44,463.27,null,null,"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.5cm/<","PX-12041","CDM",12041,"CPT",982,"RC",{"$nulls":6},"both",null,null,763.2,763.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},138.33,255.55,null,null,"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.6-7.5 Cm","PX-12042","CDM",12042,"CPT",982,"RC",{"$nulls":6},"both",null,null,896.49,896.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},186.66,300.28,null,null,"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 7.6-12.5cm","PX-12044","CDM",12044,"CPT",982,"RC",{"$nulls":6},"both",null,null,1103.34,1103.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},203.1,370.1,null,null,"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 12.6-20 Cm","PX-12045","CDM",12045,"CPT",982,"RC",{"$nulls":6},"both",null,null,1180.14,1180.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},258.24,396.43,null,null,"facility"]
["US Extremity","PX-4020075","CDM",76882,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Rpr Intermediate N/H/F/Xtrnl Gent 20.1-30.0 Cm","PX-12046","CDM",12046,"CPT",982,"RC",{"$nulls":6},"both",null,null,1412.37,1412.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},295.98,475.74,null,null,"facility"]
["Repair Intermediate F/E/E/N/L&/Muc 2.5 Cm/<","PX-12051","CDM",12051,"CPT",982,"RC",{"$nulls":6},"both",null,null,819.09,819.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},161.44,274.41,null,null,"facility"]
["Repair Intermediate F/E/E/N/L&/Muc 2.6-5.0 Cm","PX-12052","CDM",12052,"CPT",982,"RC",{"$nulls":6},"both",null,null,910.98,910.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},189.95,305.21,null,null,"facility"]
["Repair Intermediate F/E/E/N/L&/Muc 5.1-7.5 Cm","PX-12053","CDM",12053,"CPT",982,"RC",{"$nulls":6},"both",null,null,1049.4,1049.4,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},204.55,351.57,null,null,"facility"]
["Repair Intermediate F/E/E/N/L&/Muc 7.6-12.5 Cm","PX-12054","CDM",12054,"CPT",982,"RC",{"$nulls":6},"both",null,null,1099.08,1099.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},207.56,368.66,null,null,"facility"]
["Repair Complex Trunk 1.1-2.5 Cm","PX-13100","CDM",13100,"CPT",982,"RC",{"$nulls":6},"both",null,null,981.84,981.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},189.8,328.96,null,null,"facility"]
["Repair Complex Trunk 2.6-7.5 Cm","PX-13101","CDM",13101,"CPT",982,"RC",{"$nulls":6},"both",null,null,1144.44,1144.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},234.35,383.34,null,null,"facility"]
["Repair Complex Scalp/Arm/Leg 1.1-2.5 Cm","PX-13120","CDM",13120,"CPT",982,"RC",{"$nulls":6},"both",null,null,1022.88,1022.88,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},219.94,342.73,null,null,"facility"]
["Apply Compression System","PX-4902687","CDM",29584,"CPT",360,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Repair Complex Scalp/Arm/Leg 2.6-7.5 Cm","PX-13121","CDM",13121,"CPT",982,"RC",{"$nulls":6},"both",null,null,1224.93,1224.93,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},244.04,410.38,null,null,"facility"]
["Repair Complex Scalp/Arm/Leg Ea Addl 5 Cm/<","PX-13122","CDM",13122,"CPT",982,"RC",{"$nulls":6},"both",null,null,359.94,359.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},76.74,120.95,null,null,"facility"]
["Repair Complex F/C/C/M/N/Ax/G/H/F 1.1-2.5 Cm","PX-13131","CDM",13131,"CPT",982,"RC",{"$nulls":6},"both",null,null,1116.48,1116.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},228.81,374.19,null,null,"facility"]
["Repair Complex F/C/C/M/N/Ax/G/H/F 2.6-7.5 Cm","PX-13132","CDM",13132,"CPT",982,"RC",{"$nulls":6},"both",null,null,1353.66,1353.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},286,453.65,null,null,"facility"]
["Repair Complex F/C/C/M/N/Ax/G/H/F Ea Addl 5 Cm/<","PX-13133","CDM",13133,"CPT",982,"RC",{"$nulls":6},"both",null,null,477.48,477.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},117.22,160.44,null,null,"facility"]
["Repair Complex Eyelid/Nose/Ear/Lip 1.1-2.5 Cm","PX-13151","CDM",13151,"CPT",982,"RC",{"$nulls":6},"both",null,null,1213.8,1213.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},262.58,406.98,null,null,"facility"]
["Repair Complex Eyelid/Nose/Ear/Lip 2.6-7.5 Cm","PX-13152","CDM",13152,"CPT",982,"RC",{"$nulls":6},"both",null,null,1423.59,1423.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},316.35,477.45,null,null,"facility"]
["Repair Complx Eyelid/Nose/Ear/Lip Ea Addl 5 Cm/<","PX-13153","CDM",13153,"CPT",982,"RC",{"$nulls":6},"both",null,null,521.76,521.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},126.76,175.55,null,null,"facility"]
["Adjt Tis Trnsfr/Reargmt Scalp/Arm/Leg 10 Sq Cm/<","PX-14020","CDM",14020,"CPT",982,"RC",{"$nulls":6},"both",null,null,2022.72,2022.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},542.01,678.88,null,null,"facility"]
["Adjt Tis Trns/Reargmt F/C/C/M/N/a/G/H/F 10sqcm/<","PX-14040","CDM",14040,"CPT",982,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},595.59,732.78,null,null,"facility"]
["Pinch Graft 1/Mlt Sm Ulcer Tip/Oth AR Up to 2 Cm","PX-15050","CDM",15050,"CPT",982,"RC",{"$nulls":6},"both",null,null,1674.45,1674.45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},435.24,562.62,null,null,"facility"]
["Splt Agrft F/S/N/H/F/G/M/Dgt 1st 100 Sqcm/</1%","PX-15120","CDM",15120,"CPT",982,"RC",{"$nulls":6},"both",null,null,2399.61,2399.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},652.38,807.26,null,null,"facility"]
["CT Abdomen/Pelvis","PX-3520035","CDM",74176,"CPT",350,"RC",{"$nulls":6},"both",null,null,1564.6,1564.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Abdomen/Pelvis","PX-3520036","CDM",74177,"CPT",350,"RC",{"$nulls":6},"both",null,null,2427.07,2427.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Abdomen/Pelvis","PX-3520037","CDM",74178,"CPT",350,"RC",{"$nulls":6},"both",null,null,2427.07,2427.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Dexa 1 or More Sties,Axial Skeleton,W/Vfa","PX-3200277","CDM",77085,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Breast Unilateral Cmplt","PX-4020104","CDM",76641,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Breast Unilateral Lmtd","PX-4020105","CDM",76642,"CPT",402,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Tomo Screening Bilat Add-On","PX-4030005","CDM",77063,"CPT",403,"RC",{"$nulls":6},"both",null,null,129,129,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Blepharoplasty Lower Eyelid","PX-15820","CDM",15820,"CPT",982,"RC",{"$nulls":6},"both",null,null,1683.42,1683.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},499.13,563.31,null,null,"facility"]
["Blepharoplasty Upper Eyelid","PX-15822","CDM",15822,"CPT",982,"RC",{"$nulls":6},"both",null,null,1334.85,1334.85,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},384.38,447.25,null,null,"facility"]
["Colonoscopy","PX-7500106","CDM",45388,"CPT",750,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/US","PX-20611","CDM",20611,"CPT",982,"RC",{"$nulls":6},"both",null,null,284.61,284.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.26,95.53,null,null,"facility"]
["Initial Tx 1st Degree Burn Local Tx","PX-16000","CDM",16000,"CPT",982,"RC",{"$nulls":6},"both",null,null,227.25,227.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},42.32,76.37,null,null,"facility"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Small","PX-16020","CDM",16020,"CPT",982,"RC",{"$nulls":6},"both",null,null,247.14,247.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},53.11,82.91,null,null,"facility"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Medium","PX-16025","CDM",16025,"CPT",982,"RC",{"$nulls":6},"both",null,null,448.02,448.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},104.78,150.62,null,null,"facility"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Large","PX-16030","CDM",16030,"CPT",982,"RC",{"$nulls":6},"both",null,null,558,558,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},122.7,187.86,null,null,"facility"]
["Destruction Premalignant Lesion 1st","PX-17000","CDM",17000,"CPT",982,"RC",{"$nulls":6},"both",null,null,196.74,196.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},53.41,65.85,null,null,"facility"]
["Destruction Premalignant Lesion 2-14 Ea","PX-17003","CDM",17003,"CPT",982,"RC",{"$nulls":6},"both",null,null,19.65,19.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},1.96,5.57,null,null,"facility"]
["Destruction Premalignant Lesion 15/>","PX-17004","CDM",17004,"CPT",982,"RC",{"$nulls":6},"both",null,null,486,486,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},94.22,162.66,null,null,"facility"]
["Destruction Benign Lesions Up to 14","PX-17110","CDM",17110,"CPT",982,"RC",{"$nulls":6},"both",null,null,332.7,332.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},66.67,94.53,null,null,"facility"]
["Destruction Benign Lesions 15/>","PX-17111","CDM",17111,"CPT",982,"RC",{"$nulls":6},"both",null,null,387.84,387.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},80.61,129.72,null,null,"facility"]
["Chemical Cauterization of Granulation Tissue","PX-17250","CDM",17250,"CPT",982,"RC",{"$nulls":6},"both",null,null,252.51,252.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},35.74,84.52,null,null,"facility"]
["Colonoscopy Flx Ablation Tumor Polyp/Other Les","PX-45388","CDM",45388,"CPT",975,"RC",{"$nulls":6},"both",null,null,7083.63,7083.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},251.01,2363.99,null,null,"facility"]
["Intubation/Aspiration","PX-4903219","CDM",43753,"CPT",450,"RC",{"$nulls":6},"both",null,null,897.18,897.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC N Block Inj Hypogas Plxs","PX-4903255","CDM",64517,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Exploration Penetrating Wound Spx Extremity","PX-20103","CDM",20103,"CPT",982,"RC",{"$nulls":6},"both",null,null,1603.5,1603.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},323.59,539.05,null,null,"facility"]
["Removal Foreign Body Muscle/Tendon Sheath Simple","PX-20520","CDM",20520,"CPT",982,"RC",{"$nulls":6},"both",null,null,628.77,628.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},141.78,210.87,null,null,"facility"]
["Injection Therapeutic Carpal Tunnel","PX-20526","CDM",20526,"CPT",982,"RC",{"$nulls":6},"both",null,null,233.31,233.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.98,78.52,null,null,"facility"]
["Injection 1 Tendon Sheath/Ligament Aponeurosis","PX-20550","CDM",20550,"CPT",982,"RC",{"$nulls":6},"both",null,null,164.85,164.85,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},36.4,55.39,null,null,"facility"]
["Injection Single Tendon Origin/Insertion","PX-20551","CDM",20551,"CPT",982,"RC",{"$nulls":6},"both",null,null,164.49,164.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},36.23,55.22,null,null,"facility"]
["Injection Single/Mlt Trigger Point 1/2 Muscles","PX-20552","CDM",20552,"CPT",982,"RC",{"$nulls":6},"both",null,null,150.36,150.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},34.75,50.47,null,null,"facility"]
["Injection Single/Mlt Trigger Point 3/> Muscles","PX-20553","CDM",20553,"CPT",982,"RC",{"$nulls":6},"both",null,null,173.31,173.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},39.51,58.17,null,null,"facility"]
["Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O US","PX-20600","CDM",20600,"CPT",982,"RC",{"$nulls":6},"both",null,null,153.66,153.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},33.61,51.62,null,null,"facility"]
["Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O US","PX-20605","CDM",20605,"CPT",982,"RC",{"$nulls":6},"both",null,null,157.59,157.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},34.6,52.93,null,null,"facility"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O US","PX-20610","CDM",20610,"CPT",982,"RC",{"$nulls":6},"both",null,null,184.65,184.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},42.48,62.12,null,null,"facility"]
["Aspiration&/Injection Ganglion Cyst Any Locatj","PX-20612","CDM",20612,"CPT",982,"RC",{"$nulls":6},"both",null,null,186.48,186.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},38.69,62.6,null,null,"facility"]
["Behav Assmt W/Score & Docd/Stand Instrument","PX-96127","CDM",96127,"CPT",982,"RC",{"$nulls":6},"both",null,null,13.14,13.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},4.43,4.43,null,null,"facility"]
["HC Destroy Cerv/Thor Facet Jnt","PX-4902351","CDM",64633,"CPT",360,"RC",{"$nulls":6},"both",null,null,5858.31,5858.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destroy C/Th Facet Jnt Addl","PX-4902352","CDM",64634,"CPT",360,"RC",{"$nulls":6},"both",null,null,843.61,843.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destroy Lumb/Sac Facet Jnt","PX-4902353","CDM",64635,"CPT",360,"RC",{"$nulls":6},"both",null,null,5858.31,5858.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Destroy L/S Facet Jnt Addl","PX-4902354","CDM",64636,"CPT",360,"RC",{"$nulls":6},"both",null,null,1911.58,1911.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Hida Image","PX-3410075","CDM",78226,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Hida Image","PX-3410076","CDM",78227,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Treat Finger Fracture,Each","PX-4902313","CDM",26740,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Neg Pressure Wound Tx,< 50 Cm","PX-4200100","CDM",97605,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Multi Layer Compression Application","PX-4200102","CDM",29581,"CPT",360,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Swing Bed","PX-1200000","CDM",1200000,"LOCAL",120,"RC",{"$nulls":6},"both",null,null,5600,5600,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Respite Care","PX-1200002","CDM",1200002,"LOCAL",120,"RC",{"$nulls":6},"both",null,null,1477.84,1477.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Wbc Auto","PX-LH300001","CDM",85048,"CPT",300,"RC",{"$nulls":6},"both",null,null,7.62,7.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh RBC Auto","PX-LH300002","CDM",85041,"CPT",300,"RC",{"$nulls":6},"both",null,null,9.06,9.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hgb","PX-LH300003","CDM",85018,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hct","PX-LH300004","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Platelets Auto","PX-LH300005","CDM",85049,"CPT",300,"RC",{"$nulls":6},"both",null,null,35,35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Esr Auto","PX-LH300006","CDM",85652,"CPT",300,"RC",{"$nulls":6},"both",null,null,21,21,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Retic % Auto","PX-LH300007","CDM",85045,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Etoh Serum","PX-LH300008","CDM",80320,"CPT",300,"RC",{"$nulls":6},"both",null,null,349.29,349.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Glucose Bld Excl Reag Strp","PX-LH300009","CDM",82947,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bun Quant","PX-LH300010","CDM",84520,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Creatinine, Blood","PX-LH300011","CDM",82565,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Na Ser/Plas/Bld","PX-LH300013","CDM",84295,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh K+ Ser/Pls/Bld","PX-LH300014","CDM",84132,"CPT",300,"RC",{"$nulls":6},"both",null,null,30,30,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chloride Blood","PX-LH300015","CDM",82435,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Co 2","PX-LH300016","CDM",82374,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Amylase","PX-LH300017","CDM",82150,"CPT",300,"RC",{"$nulls":6},"both",null,null,51,51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alt (Sgpt)","PX-LH300018","CDM",84460,"CPT",300,"RC",{"$nulls":6},"both",null,null,36,36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ast (Sgot)","PX-LH300019","CDM",84450,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alk Phos","PX-LH300020","CDM",84075,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Troponin I","PX-LH300021","CDM",84484,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Albumin Ser/Plas/Bld","PX-LH300022","CDM",82040,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T Protein Urine 24 Hr Ref","PX-LH300023","CDM",84156,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Total Protein","PX-LH300024","CDM",84155,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Total Bilirubin","PX-LH300025","CDM",82247,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Direct Bilirubin","PX-LH300026","CDM",82248,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ldh","PX-LH300027","CDM",83615,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Calcium Total","PX-LH300028","CDM",82310,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh CK (Crea Kinase) Total","PX-LH300029","CDM",82550,"CPT",300,"RC",{"$nulls":6},"both",null,null,50,50,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh CK-Mb","PX-LH300030","CDM",82553,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gamma-Gt","PX-LH300031","CDM",82977,"CPT",300,"RC",{"$nulls":6},"both",null,null,58,58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Magnesium","PX-LH300032","CDM",83735,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Phosphorus","PX-LH300033","CDM",84100,"CPT",300,"RC",{"$nulls":6},"both",null,null,36,36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Uric Acid Blood","PX-LH300034","CDM",84550,"CPT",300,"RC",{"$nulls":6},"both",null,null,36,36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cholesterol Ser/Bld Total","PX-LH300035","CDM",82465,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Triglycerides","PX-LH300036","CDM",84478,"CPT",300,"RC",{"$nulls":6},"both",null,null,46,46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hdl Cholesterol","PX-LH300038","CDM",83718,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.57,24.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T4 Total Ref","PX-LH300039","CDM",84436,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T3 Uptake Ref","PX-LH300040","CDM",84479,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.41,19.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tsh","PX-LH300041","CDM",84443,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Digoxin Total","PX-LH300042","CDM",80162,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dilantin Total","PX-LH300043","CDM",80185,"CPT",300,"RC",{"$nulls":6},"both",null,null,103,103,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Theophyline Ref","PX-LH300044","CDM",80198,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aptt","PX-LH300045","CDM",85730,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gram Stain","PX-LH300047","CDM",87205,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Tumor Soft Tissue Back/Flank Subq <3cm","PX-21930","CDM",21930,"CPT",982,"RC",{"$nulls":6},"both",null,null,1430.52,1430.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},346.38,481.61,null,null,"facility"]
["Lh Culture Anaerobe Ref.","PX-LH300048","CDM",87075,"CPT",300,"RC",{"$nulls":6},"both",null,null,75,75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Ear Ref","PX-LH300049","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Eye Ref","PX-LH300050","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Fluid Ref","PX-LH300051","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture N/P Ref","PX-LH300052","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Nose Ref","PX-LH300053","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Penis Ref","PX-LH300054","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Rectal Ref","PX-LH300055","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Spinal Ref","PX-LH300056","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Sputum Ref","PX-LH300057","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Throat Ref","PX-LH300058","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urine Bact Cult ID, Each","PX-LH300059","CDM",87088,"CPT",300,"RC",{"$nulls":6},"both",null,null,68,68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Vaginal Ref","PX-LH300060","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Wound Ref","PX-LH300061","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sensitivity Ea Multi-Antimicrob per Plate","PX-LH300062","CDM",87186,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bca Ref","PX-LH300063","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bcan","PX-LH300066","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cbc Auto W Auto Diff Wbc WC","PX-LH300070","CDM",85025,"CPT",300,"RC",{"$nulls":6},"both",null,null,56,56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cold Aggl Screening","PX-LH300071","CDM",86156,"CPT",300,"RC",{"$nulls":6},"both",null,null,46,46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Neurobeh Status Exam by Psych/Phys","PX-9180002","CDM",96116,"CPT",918,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Crystals","PX-LH300072","CDM",89060,"CPT",300,"RC",{"$nulls":6},"both",null,null,56,56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gastrocult Feces Colrctl Ca 1-3 Cards","PX-LH300073","CDM",82270,"CPT",300,"RC",{"$nulls":6},"both",null,null,13.14,13.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Glucose Bld Excl Reag Strp WC/Lc","PX-LH300074","CDM",82947,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hct WC","PX-LH300075","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Blood Count; Leukocyte (Wbc)","PX-LH300076","CDM",85048,"CPT",300,"RC",{"$nulls":6},"both",null,null,7.62,7.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mono","PX-LH300077","CDM",86308,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mono WC","PX-LH300078","CDM",86308,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Occult Blood Perox Acty Excl Colrctl Ca 1-3 Simult, Diagnostic","PX-LH300079","CDM",82272,"CPT",300,"RC",{"$nulls":6},"both",null,null,12.69,12.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Occult Blood Perox Acty Excl Colrctl Ca WC 1-3 Simult","PX-LH300082","CDM",82272,"CPT",300,"RC",{"$nulls":6},"both",null,null,12.69,12.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Platelets Auto WC","PX-LH300086","CDM",85048,"CPT",300,"RC",{"$nulls":6},"both",null,null,7.62,7.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pregnancy Qual","PX-LH300087","CDM",84703,"CPT",300,"RC",{"$nulls":6},"both",null,null,59,59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pregnancy Qual WC","PX-LH300088","CDM",84703,"CPT",300,"RC",{"$nulls":6},"both",null,null,59,59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ua Auto W/ Micro Walhalla Clinic","PX-LH300090","CDM",81001,"CPT",300,"RC",{"$nulls":6},"both",null,null,23,23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ua Munich Clinic","PX-LH300091","CDM",81003,"CPT",300,"RC",{"$nulls":6},"both",null,null,19,19,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Wbc Auto WC","PX-LH300092","CDM",85048,"CPT",300,"RC",{"$nulls":6},"both",null,null,7.62,7.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Abo","PX-LH300093","CDM",86900,"CPT",300,"RC",{"$nulls":6},"both",null,null,128.9,128.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bld Type Rh","PX-LH300094","CDM",86901,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.25,39.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antibody Screen RBC Ea Ser Techniq","PX-LH300095","CDM",86850,"CPT",300,"RC",{"$nulls":6},"both",null,null,160.29,160.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coombs (Dat) Ref","PX-LH300096","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Xmatcha 1 Antiglob Techniq","PX-LH300098","CDM",86922,"CPT",300,"RC",{"$nulls":6},"both",null,null,488.22,488.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Xmatch 1 Incub Techniq (Igm)","PX-LH300104","CDM",86921,"CPT",300,"RC",{"$nulls":6},"both",null,null,488.22,488.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Plt. Pheresis Fa","PX-LH300117","CDM",36513,"CPT",300,"RC",{"$nulls":6},"both",null,null,1240.83,1240.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh 17 Keto-Sterioi Total","PX-LH300121","CDM",83593,"CPT",300,"RC",{"$nulls":6},"both",null,null,85.5,85.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh 5hiaa Ref","PX-LH300122","CDM",83497,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.7,38.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alcohol Breath Ref","PX-LH300123","CDM",82075,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aldolase Ref","PX-LH300124","CDM",82085,"CPT",300,"RC",{"$nulls":6},"both",null,null,29.13,29.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aldosterone-Ser Ref","PX-LH300125","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aldosterone-Uri","PX-LH300126","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alk Phos-Bone Ref","PX-LH300127","CDM",84075,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh a-Feto-Protein Serum Ref","PX-LH300128","CDM",82105,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ammonia Ref","PX-LH300129","CDM",82140,"CPT",300,"RC",{"$nulls":6},"both",null,null,109,109,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti Cardiolpi Ref","PX-LH300130","CDM",86147,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti-Dna Ref Native/Doubl","PX-LH300131","CDM",86225,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aso Ref","PX-LH300132","CDM",86060,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C-Anca Ref Leukocyte","PX-LH300134","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C-Peptide Ref","PX-LH300135","CDM",84681,"CPT",300,"RC",{"$nulls":6},"both",null,null,62.43,62.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C-Reactive Protein","PX-LH300136","CDM",86140,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ca 125 Ref","PX-LH300137","CDM",86304,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Caffine Ref","PX-LH300138","CDM",86304,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Calc Urine Ref","PX-LH300139","CDM",82340,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Carboxy Hgb Ref","PX-LH300141","CDM",82375,"CPT",300,"RC",{"$nulls":6},"both",null,null,59,59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cathecholamines Ref","PX-LH300142","CDM",82384,"CPT",300,"RC",{"$nulls":6},"both",null,null,197,197,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cea Ref","PX-LH300143","CDM",82378,"CPT",300,"RC",{"$nulls":6},"both",null,null,144,144,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ceruloplasin R","PX-LH300144","CDM",82390,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ch 50 Ref","PX-LH300145","CDM",86162,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.96,60.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chy Slide Stain","PX-LH300146","CDM",83518,"CPT",300,"RC",{"$nulls":6},"both",null,null,114.22,114.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chlamydia Probe Ref","PX-LH300147","CDM",87491,"CPT",300,"RC",{"$nulls":6},"both",null,null,84,84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Complement C Ref","PX-LH300149","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cmp 4 Ref","PX-LH300150","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coproporpyrins","PX-LH300151","CDM",84120,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.22,44.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisol Total-Serum","PX-LH300152","CDM",82533,"CPT",300,"RC",{"$nulls":6},"both",null,null,128,128,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisol Free-Urine","PX-LH300153","CDM",82530,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.13,50.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Stool Ref Salm/Shig","PX-LH300155","CDM",87045,"CPT",300,"RC",{"$nulls":6},"both",null,null,75,75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Viral","PX-LH300156","CDM",87252,"CPT",300,"RC",{"$nulls":6},"both",null,null,78.21,78.21,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cyclolsporine Ref","PX-LH300157","CDM",80158,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh D-Dimer Quant","PX-LH300158","CDM",85379,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Disopyramide R","PX-LH300159","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebv, Early Ag","PX-LH300160","CDM",86663,"CPT",300,"RC",{"$nulls":6},"both",null,null,103,103,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Endomysial Ab 1","PX-LH300161","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Estriol Ref","PX-LH300162","CDM",82677,"CPT",300,"RC",{"$nulls":6},"both",null,null,188,188,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Estrogen Total Ref","PX-LH300163","CDM",82672,"CPT",300,"RC",{"$nulls":6},"both",null,null,65.1,65.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Extrac Nuc Ab","PX-LH300164","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor 9 Ref","PX-LH300165","CDM",85250,"CPT",300,"RC",{"$nulls":6},"both",null,null,57.12,57.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor 11 Ref","PX-LH300166","CDM",85270,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor 13 Ref Clotting; Factor IX (Ptc or Christmas)","PX-LH300167","CDM",85250,"CPT",300,"RC",{"$nulls":6},"both",null,null,57.12,57.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fana Ref","PX-LH300168","CDM",86038,"CPT",300,"RC",{"$nulls":6},"both",null,null,96,96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fecal Fat Qual Ref","PX-LH300169","CDM",82705,"CPT",300,"RC",{"$nulls":6},"both",null,null,15.3,15.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ferritin","PX-LH300170","CDM",82728,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fibrinogen Ref Activity","PX-LH300171","CDM",85384,"CPT",300,"RC",{"$nulls":6},"both",null,null,66,66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Folate","PX-LH300172","CDM",82746,"CPT",300,"RC",{"$nulls":6},"both",null,null,115,115,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Free Psa Ref","PX-LH300173","CDM",84154,"CPT",300,"RC",{"$nulls":6},"both",null,null,55.17,55.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Free T4 Ref","PX-LH300174","CDM",84439,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fsh Ref","PX-LH300175","CDM",83001,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gastrin Ref","PX-LH300176","CDM",82941,"CPT",300,"RC",{"$nulls":6},"both",null,null,136,136,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gc Amp Probe Ref","PX-LH300177","CDM",87591,"CPT",300,"RC",{"$nulls":6},"both",null,null,84,84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gentamicin","PX-LH300178","CDM",80170,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.14,49.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Glucagon Ref","PX-LH300179","CDM",82943,"CPT",300,"RC",{"$nulls":6},"both",null,null,42.87,42.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Haptoglobin; Quantitative","PX-LH300180","CDM",83010,"CPT",300,"RC",{"$nulls":6},"both",null,null,100,100,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcg, Serum Quant Ref","PX-LH300181","CDM",84702,"CPT",300,"RC",{"$nulls":6},"both",null,null,119,119,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Helicobacter Py","PX-LH300182","CDM",86677,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.55,50.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis Panel, Acute","PX-LH300183","CDM",80074,"CPT",300,"RC",{"$nulls":6},"both",null,null,142.89,142.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis Profile Acute","PX-LH300184","CDM",80074,"CPT",300,"RC",{"$nulls":6},"both",null,null,142.89,142.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis C Profile Rna","PX-LH300186","CDM",87522,"CPT",300,"RC",{"$nulls":6},"both",null,null,332,332,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hbsag Ref","PX-LH300187","CDM",87340,"CPT",300,"RC",{"$nulls":6},"both",null,null,31.75,31.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis C Ref","PX-LH300188","CDM",86803,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hgb Electrophor","PX-LH300189","CDM",83020,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.61,38.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Histone Ref","PX-LH300190","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hiv-1 State Ref","PX-LH300191","CDM",86701,"CPT",300,"RC",{"$nulls":6},"both",null,null,26.67,26.67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hiv 1 Ref","PX-LH300192","CDM",87389,"CPT",300,"RC",{"$nulls":6},"both",null,null,162,162,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hla B27 Ref","PX-LH300193","CDM",86812,"CPT",300,"RC",{"$nulls":6},"both",null,null,201,201,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Homocysteine Ref","PX-LH300194","CDM",83090,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Htlv-1 Ref","PX-LH300195","CDM","LH300195","LOCAL",300,"RC",{"$nulls":6},"both",null,null,36,36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hva Ref","PX-LH300196","CDM",83150,"CPT",300,"RC",{"$nulls":6},"both",null,null,67.23,67.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hydroxproline Total U","PX-LH300197","CDM",83505,"CPT",300,"RC",{"$nulls":6},"both",null,null,72.9,72.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ibc","PX-LH300198","CDM",83550,"CPT",300,"RC",{"$nulls":6},"both",null,null,72,72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Igg Ref","PX-LH300199","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Igm Ref","PX-LH300200","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Immunofixation","PX-LH300202","CDM",86334,"CPT",300,"RC",{"$nulls":6},"both",null,null,174,174,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza Ab A","PX-LH300203","CDM",86710,"CPT",300,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza Ab B","PX-LH300204","CDM",86710,"CPT",300,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Iron","PX-LH300205","CDM",83540,"CPT",300,"RC",{"$nulls":6},"both",null,null,51,51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh K Urine Ref","PX-LH300206","CDM",84133,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh K Stool Ref","PX-LH300207","CDM",84999,"CPT",300,"RC",{"$nulls":6},"both",null,null,14.46,14.46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lead Ref","PX-LH300208","CDM",83655,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lh Ref","PX-LH300209","CDM",83002,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lipase","PX-LH300210","CDM",83690,"CPT",300,"RC",{"$nulls":6},"both",null,null,56,56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lithium Ref","PX-LH300211","CDM",80178,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lyme Disease Ref","PX-LH300212","CDM",86618,"CPT",300,"RC",{"$nulls":6},"both",null,null,132,132,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Metanephrines Urine Ref","PX-LH300213","CDM",83835,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.82,50.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Methylmolonic A","PX-LH300214","CDM",83921,"CPT",300,"RC",{"$nulls":6},"both",null,null,135,135,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mitochondrial A","PX-LH300215","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mycoplasma Pneu","PX-LH300216","CDM",86738,"CPT",300,"RC",{"$nulls":6},"both",null,null,103,103,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Na Stool Ref","PX-LH300217","CDM",84999,"CPT",300,"RC",{"$nulls":6},"both",null,null,14.46,14.46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Na Urine Ref","PX-LH300218","CDM",84300,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nap Ref","PX-LH300219","CDM",80192,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.25,50.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Neuron Ref","PX-LH300220","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Neurontin (Gaba)","PX-LH300221","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nortriptyline","PX-LH300222","CDM",80335,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh O & P Ref","PX-LH300223","CDM",87177,"CPT",300,"RC",{"$nulls":6},"both",null,null,74,74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Osmolality Serum","PX-LH300224","CDM",83930,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Osmolality Stool","PX-LH300225","CDM",84999,"CPT",300,"RC",{"$nulls":6},"both",null,null,14.46,14.46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pku Ref","PX-LH300226","CDM",84030,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.5,16.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Porphobilinoge Quant","PX-LH300227","CDM",84110,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.32,25.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Porphyrines Ref","PX-LH300228","CDM",84120,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.31,44.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pra Ref","PX-LH300229","CDM",84244,"CPT",300,"RC",{"$nulls":6},"both",null,null,172,172,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cascading Relex (Ref)","PX-LH300230","CDM",86038,"CPT",300,"RC",{"$nulls":6},"both",null,null,96,96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anaplasma Pcr Amp Ref","PX-LH300299","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Extractable Antigen Sm/Rnp Ref","PX-LH300300","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antigranulocyte Ab Ref","PX-LH300301","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mumps Virus","PX-LH300302","CDM",86735,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Varicella Zoster Igm Ref","PX-LH300329","CDM",86787,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Prenatal Pro Re","PX-LH300330","CDM",80055,"CPT",300,"RC",{"$nulls":6},"both",null,null,143.43,143.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Procainamide W/ Metabolites","PX-LH300331","CDM",80192,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.25,50.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Progesterone Ref","PX-LH300332","CDM",84144,"CPT",300,"RC",{"$nulls":6},"both",null,null,161,161,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Prolactin Ref","PX-LH300333","CDM",84146,"CPT",300,"RC",{"$nulls":6},"both",null,null,152,152,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Protein Electro Ser Ref","PX-LH300334","CDM",84165,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor VII Ref","PX-LH300335","CDM",85230,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pth Ref","PX-LH300336","CDM",83970,"CPT",300,"RC",{"$nulls":6},"both",null,null,319,319,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Quinidin Ref","PX-LH300337","CDM",80194,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.8,43.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ra Factor Quant","PX-LH300338","CDM",86431,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ritalin Ref","PX-LH300339","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rpr Qual Ref","PX-LH300340","CDM",86592,"CPT",300,"RC",{"$nulls":6},"both",null,null,192,192,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rsv Culture Ref","PX-LH300341","CDM",87252,"CPT",300,"RC",{"$nulls":6},"both",null,null,78.21,78.21,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rubella Screen","PX-LH300342","CDM",86762,"CPT",300,"RC",{"$nulls":6},"both",null,null,113,113,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Salicylates Ref","PX-LH300343","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Smear Special Grp II Ref","PX-LH300344","CDM",88313,"CPT",300,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sjogren's Antibody Ref","PX-LH300345","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Stone Kidney Infrd Spect","PX-LH300346","CDM",82365,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Strep Screen Ref","PX-LH300347","CDM",87880,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.59,49.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tbg Ref","PX-LH300348","CDM",84442,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.34,44.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tegretol Total","PX-LH300349","CDM",80156,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.71,43.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Testosterone Total Ref","PX-LH300350","CDM",84403,"CPT",300,"RC",{"$nulls":6},"both",null,null,201,201,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thyroglobulin A","PX-LH300351","CDM",86800,"CPT",300,"RC",{"$nulls":6},"both",null,null,126,126,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Level 1","PX-LH300352","CDM",88300,"CPT",300,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Level 2","PX-LH300353","CDM",88302,"CPT",300,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Level 3","PX-LH300354","CDM",88304,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Level 4","PX-LH300355","CDM",88305,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Level 5","PX-LH300356","CDM",88307,"CPT",300,"RC",{"$nulls":6},"both",null,null,1027.44,1027.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Level 6","PX-LH300357","CDM",88309,"CPT",300,"RC",{"$nulls":6},"both",null,null,2457.87,2457.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Transferrin","PX-LH300359","CDM",84466,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Uric Acid 24 UR","PX-LH300360","CDM",84560,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Valproic Acid Ref Total","PX-LH300361","CDM",80164,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vancomycin Ref","PX-LH300362","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Viral Resp Adult Adenovirus Ab","PX-LH300363","CDM",86603,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.61,38.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Viral Resp Child Adenovirus Ab","PX-LH300364","CDM",86603,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.61,38.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin B12","PX-LH300365","CDM",82607,"CPT",300,"RC",{"$nulls":6},"both",null,null,119,119,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin D Panel Ref","PX-LH300366","CDM",82652,"CPT",300,"RC",{"$nulls":6},"both",null,null,297,297,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vma Ref","PX-LH300367","CDM",84585,"CPT",300,"RC",{"$nulls":6},"both",null,null,46.5,46.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Wbc Stool Ref","PX-LH300368","CDM",89055,"CPT",300,"RC",{"$nulls":6},"both",null,null,42,42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Xylose Tolerance","PX-LH300369","CDM",84620,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.73,38.73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Zpp Quant Ref","PX-LH300370","CDM",84202,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.05,43.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Parasite ID Re","PX-LH300371","CDM",87999,"CPT",300,"RC",{"$nulls":6},"both",null,null,218.8,218.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cytology Ua Ref","PX-LH300372","CDM",88108,"CPT",300,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alpha 1 Antitry Total","PX-LH300373","CDM",82103,"CPT",300,"RC",{"$nulls":6},"both",null,null,104,104,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Smooth Muscle A","PX-LH300374","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Erythropoeitin","PX-LH300375","CDM",82668,"CPT",300,"RC",{"$nulls":6},"both",null,null,147,147,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antithrombin III Activity","PX-LH300376","CDM",85300,"CPT",300,"RC",{"$nulls":6},"both",null,null,93,93,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cmplement C1q","PX-LH300377","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh P-Anca Ref Leukocyte","PX-LH300378","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ca27.29 Ref","PX-LH300379","CDM",86300,"CPT",300,"RC",{"$nulls":6},"both",null,null,62.43,62.43,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Phenobarbital Ref","PX-LH300380","CDM",80184,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.9,45.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mixing Study Ptt","PX-LH300381","CDM",85730,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cmv Ab, Igg, Se","PX-LH300382","CDM",86644,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thyroid Peroxid","PX-LH300383","CDM",86376,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ena","PX-LH300384","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Russell Viper Venom Time; Diluted","PX-LH300385","CDM",85613,"CPT",300,"RC",{"$nulls":6},"both",null,null,28.74,28.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Von Willebrand Antigen","PX-LH300386","CDM",85246,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Leuko Alk Phos","PX-LH300387","CDM",85540,"CPT",300,"RC",{"$nulls":6},"both",null,null,130.84,130.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Semen Analysis Presence/Motility of Sperm","PX-LH300388","CDM",89300,"CPT",300,"RC",{"$nulls":6},"both",null,null,29.52,29.52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Crp High Sensitiv Ref","PX-LH300389","CDM",86141,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dhea-Sulfate R","PX-LH300390","CDM",82627,"CPT",300,"RC",{"$nulls":6},"both",null,null,66.69,66.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acid Phos Prost","PX-LH300391","CDM",84066,"CPT",300,"RC",{"$nulls":6},"both",null,null,28.98,28.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fragile X Study","PX-LH300392","CDM",81243,"CPT",300,"RC",{"$nulls":6},"both",null,null,171.12,171.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chromosome Analysis CT 15-20 Cells","PX-LH300393","CDM",88262,"CPT",300,"RC",{"$nulls":6},"both",null,null,376.47,376.47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis a Igm Ref","PX-LH300394","CDM",86709,"CPT",300,"RC",{"$nulls":6},"both",null,null,76,76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nucleotidase R","PX-LH300395","CDM",83915,"CPT",300,"RC",{"$nulls":6},"both",null,null,33.45,33.45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Prot Electro Ua Ref","PX-LH300396","CDM",84166,"CPT",300,"RC",{"$nulls":6},"both",null,null,144,144,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lipoprotein (a) Re","PX-LH300397","CDM",83695,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rabies Antibody","PX-LH300398","CDM",86317,"CPT",300,"RC",{"$nulls":6},"both",null,null,113,113,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cystine, Urine Sngl Quant Ea Specmn","PX-LH300399","CDM",82131,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.94,68.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Oxalate, Urine","PX-LH300400","CDM",83945,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Osmolality, Urine","PX-LH300401","CDM",83935,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Renin, Serum R","PX-LH300402","CDM",84244,"CPT",300,"RC",{"$nulls":6},"both",null,null,172,172,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chloride, Urine","PX-LH300403","CDM",82436,"CPT",300,"RC",{"$nulls":6},"both",null,null,35,35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Eosinophil Coun","PX-LH300404","CDM",85008,"CPT",300,"RC",{"$nulls":6},"both",null,null,10.29,10.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cryoglobulins Qual/Semi-Quant","PX-LH300405","CDM",82595,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.41,19.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetaminophen","PX-LH300406","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Citrate Urine R","PX-LH300407","CDM",82507,"CPT",300,"RC",{"$nulls":6},"both",null,null,216,216,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Magnesium Urine","PX-LH300408","CDM",83735,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Phosphate Urine","PX-LH300409","CDM",84105,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ph Urine Ref","PX-LH300410","CDM",83986,"CPT",300,"RC",{"$nulls":6},"both",null,null,334,334,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Herpes Zoster R","PX-LH300411","CDM",86787,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebna, Ab, Igg","PX-LH300412","CDM",86664,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebv Capsid Ag","PX-LH300413","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cmv Ab, Igm Re","PX-LH300414","CDM",86645,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.55,50.55,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Neut Cytoplasmi","PX-LH300415","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hiv 1/Hiv-2 Ei","PX-LH300416","CDM",87389,"CPT",300,"RC",{"$nulls":6},"both",null,null,162,162,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Iga Ref","PX-LH300417","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Estradiol Total Ref","PX-LH300418","CDM",82670,"CPT",300,"RC",{"$nulls":6},"both",null,null,217,217,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Insulin, Serum Total","PX-LH300419","CDM",83525,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vit D-Oh, D2, D3","PX-LH300420","CDM",82306,"CPT",300,"RC",{"$nulls":6},"both",null,null,228,228,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ige Ref","PX-LH300421","CDM",82785,"CPT",300,"RC",{"$nulls":6},"both",null,null,129,129,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Myoglobin, Urine","PX-LH300422","CDM",83874,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.76,38.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aspergillus Ab","PX-LH300423","CDM",86606,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hep C Rna Pcr R","PX-LH300424","CDM",87521,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Koh Prep Skn/Hair/Nl","PX-LH300425","CDM",87220,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Wet Mount","PX-LH300426","CDM",87210,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hemo-Chrom Ref","PX-LH300427","CDM",81256,"CPT",300,"RC",{"$nulls":6},"both",null,null,196.08,196.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Heavy Metal Urin Arsenic","PX-LH300428","CDM",82175,"CPT",300,"RC",{"$nulls":6},"both",null,null,149,149,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Immuno Elec UR","PX-LH300429","CDM",86335,"CPT",300,"RC",{"$nulls":6},"both",null,null,227,227,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Kappa/Lambda Light Chain,Each","PX-LH300430","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Metanephrines","PX-LH300431","CDM",83835,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.82,50.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rotavirus Stool","PX-LH300432","CDM",87425,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flecainide Ref","PX-LH300433","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Eosinophils Ua Ref","PX-LH300434","CDM",85999,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Aero Addl Def ID","PX-LH300435","CDM",87077,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rapid Strep","PX-LH300436","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis B Cor","PX-LH300437","CDM",86704,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis B Sur","PX-LH300438","CDM",86706,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rapid Strep WC","PX-LH300439","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Topiramate Ref","PX-LH300440","CDM",80201,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Calcium, Ionize","PX-LH300441","CDM",82330,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Microalbumin Quant","PX-LH300442","CDM",82043,"CPT",300,"RC",{"$nulls":6},"both",null,null,17.34,17.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Stool Ref Non-Salm/Shig","PX-LH300443","CDM",87046,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture Fungal Skn,Hair,Nail","PX-LH300444","CDM",87101,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.13,23.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coccidioides An","PX-LH300445","CDM",86635,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.41,34.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sputum to State","PX-LH300446","CDM",87118,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.83,43.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tobramycin Level Ref","PX-LH300447","CDM",80200,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.39,48.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tobramycin Trough Ref","PX-LH300448","CDM",80200,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.39,48.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Beta 2 Microglobulin","PX-LH300450","CDM",82232,"CPT",300,"RC",{"$nulls":6},"both",null,null,122,122,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Giarida Ag, Stool","PX-LH300451","CDM",87329,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.14,43.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hla Dr & Dq Re","PX-LH300452","CDM",86817,"CPT",300,"RC",{"$nulls":6},"both",null,null,318.42,318.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hla a,B,C Ref","PX-LH300453","CDM",86813,"CPT",300,"RC",{"$nulls":6},"both",null,null,174,174,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Varicella Ab, 1","PX-LH300454","CDM",86787,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hydroxyprogesterone, 17-D","PX-LH300455","CDM",83498,"CPT",300,"RC",{"$nulls":6},"both",null,null,212,212,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor II Ref","PX-LH300457","CDM",85210,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.94,38.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ristocetin Ref","PX-LH300458","CDM",85245,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Calcitonin Ref","PX-LH300459","CDM",82308,"CPT",300,"RC",{"$nulls":6},"both",null,null,200,200,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ca 19-9 Ref Tumor Antigen","PX-LH300460","CDM",86316,"CPT",300,"RC",{"$nulls":6},"both",null,null,158,158,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisol Stimul","PX-LH300461","CDM",80400,"CPT",300,"RC",{"$nulls":6},"both",null,null,97.86,97.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tacrolimus","PX-LH300462","CDM",80197,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gliadin Ab, Igg","PX-LH300463","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urine Microalbumin Quant-WC","PX-LH300464","CDM",82043,"CPT",300,"RC",{"$nulls":6},"both",null,null,17.34,17.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Immunoglobulins","PX-LH300465","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Afb Smear Ref","PX-LH300466","CDM",87206,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.17,16.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Free T3 Ref","PX-LH300467","CDM",84481,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sporotrichosis","PX-LH300468","CDM",86671,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Igf-1","PX-LH300469","CDM",84305,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bcr Abl Translo","PX-LH300470","CDM",88237,"CPT",300,"RC",{"$nulls":6},"both",null,null,431.25,431.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urea Nitrogen R Urine","PX-LH300471","CDM",84540,"CPT",300,"RC",{"$nulls":6},"both",null,null,36,36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Testosterone Fr","PX-LH300473","CDM",84402,"CPT",300,"RC",{"$nulls":6},"both",null,null,199,199,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Somatomedin Igf","PX-LH300474","CDM",84305,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anafranil, Serum","PX-LH300475","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Complement, Eac","PX-LH300476","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thyroglobulin","PX-LH300477","CDM",84432,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.18,48.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti-Phospholipid Panel Ref","PX-LH300478","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ethsuxidmide Ref","PX-LH300479","CDM",80168,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.02,49.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rapamune Ref","PX-LH300480","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Methylphenidate","PX-LH300481","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tsh Reflex Ref","PX-LH300482","CDM",84443,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pth/Rp Ref","PX-LH300483","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Carotene Ref","PX-LH300484","CDM",82380,"CPT",300,"RC",{"$nulls":6},"both",null,null,27.66,27.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor V Mut","PX-LH300486","CDM",81241,"CPT",300,"RC",{"$nulls":6},"both",null,null,170,170,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Protein C Activity Ref","PX-LH300487","CDM",85303,"CPT",300,"RC",{"$nulls":6},"both",null,null,108,108,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Protein S Free Ref","PX-LH300488","CDM",85306,"CPT",300,"RC",{"$nulls":6},"both",null,null,93,93,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cardiolipin Ab","PX-LH300489","CDM",86147,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Activated Prot","PX-LH300490","CDM",85335,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.61,38.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Prothrombin Gen Ref","PX-LH300491","CDM",85610,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cannabinoids Natural Ref","PX-LH300493","CDM",80349,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ptotein Immuno Elec, Ser","PX-LH300494","CDM",84165,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dna Double","PX-LH300495","CDM",86225,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Heavy Metal Blood Ref Lead","PX-LH300496","CDM",83655,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Asca Iga, Igg Ref","PX-LH300497","CDM",86671,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tis Transflut A","PX-LH300498","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ace Ref","PX-LH300499","CDM",82164,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Celiac Sprue Re","PX-LH300501","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Blood Gases 2/> Analytes","PX-LH300502","CDM",82803,"CPT",300,"RC",{"$nulls":6},"both",null,null,137,137,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Creatinine Clearance","PX-LH300503","CDM",82575,"CPT",300,"RC",{"$nulls":6},"both",null,null,28.38,28.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cbc Auto W Auto Diff Wbc(H-1)","PX-LH300504","CDM",85025,"CPT",300,"RC",{"$nulls":6},"both",null,null,56,56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cbc Auto W/O Diff(H-4)","PX-LH300505","CDM",85027,"CPT",300,"RC",{"$nulls":6},"both",null,null,51,51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh H-6","PX-LH300506","CDM",85007,"CPT",300,"RC",{"$nulls":6},"both",null,null,28,28,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hba 1c","PX-LH300507","CDM",83036,"CPT",300,"RC",{"$nulls":6},"both",null,null,76,76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-1 Basic Metabolic","PX-LH300508","CDM",80048,"CPT",300,"RC",{"$nulls":6},"both",null,null,68,68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-2 Electrolyte Panel","PX-LH300509","CDM",80051,"CPT",300,"RC",{"$nulls":6},"both",null,null,21.03,21.03,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-3 Cmp","PX-LH300510","CDM",80053,"CPT",300,"RC",{"$nulls":6},"both",null,null,82,82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-4 Hepatic Function Panel","PX-LH300511","CDM",80076,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Profile 5 Lipid Panel","PX-LH300512","CDM",80061,"CPT",300,"RC",{"$nulls":6},"both",null,null,96,96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-6 Renal Function Panel","PX-LH300513","CDM",80069,"CPT",300,"RC",{"$nulls":6},"both",null,null,67,67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Protime","PX-LH300514","CDM",85610,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urine Microalbuim(U-1) Seimquant","PX-LH300515","CDM",82044,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ua Auto W/ Micro","PX-LH300516","CDM",81001,"CPT",300,"RC",{"$nulls":6},"both",null,null,23,23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ua-Micro","PX-LH300517","CDM",81015,"CPT",300,"RC",{"$nulls":6},"both",null,null,9.15,9.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Phosphrous Ua Ref","PX-LH300518","CDM",84105,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Phenytoin Free","PX-LH300519","CDM",80186,"CPT",300,"RC",{"$nulls":6},"both",null,null,103,103,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pth Antibody Ref.","PX-LH300520","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Psa Hyb, Total Diagnostic","PX-LH300521","CDM",84153,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh RBC P-Porphyrin Quant Ref.","PX-LH300522","CDM",84202,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.05,43.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Culture, Other Aerob.","PX-LH300523","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thrombin Time Plasma","PX-LH300524","CDM",85670,"CPT",300,"RC",{"$nulls":6},"both",null,null,17.31,17.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Htlv I & II Reflex","PX-LH300525","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Histamine Ua","PX-LH300526","CDM",83088,"CPT",300,"RC",{"$nulls":6},"both",null,null,238,238,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Propanolol Lab Test","PX-LH300527","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chloride Stool Ref","PX-LH300529","CDM",82438,"CPT",300,"RC",{"$nulls":6},"both",null,null,15,15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chlamydia Igm Ab Serum","PX-LH300530","CDM",86632,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.04,38.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Legionella Urine R","PX-LH300531","CDM",87449,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Malaria, Blood Ref.","PX-LH300532","CDM",87207,"CPT",300,"RC",{"$nulls":6},"both",null,null,17.97,17.97,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebv,Capsid HB, Igm Ref.","PX-LH300533","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Centromere Antibody Ref.","PX-LH300534","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rnp Antibody Ref.","PX-LH300535","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Intrinsic Factor Antibodies","PX-LH300536","CDM",86340,"CPT",300,"RC",{"$nulls":6},"both",null,null,119,119,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Viscosity, Serum Ref","PX-LH300537","CDM",85810,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.01,35.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Psa Cancer Screen","PX-LH300538","CDM","G0103","CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ketone Bodies Plama Quant Ref","PX-LH300539","CDM",82010,"CPT",300,"RC",{"$nulls":6},"both",null,null,63,63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Arylsulfatase Serum Ref Spectrophotometry, Analyte Nos","PX-LH300540","CDM",84311,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.3,24.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Arylsulfatase Urine Ref","PX-LH300541","CDM",84311,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.3,24.3,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti X a Ref (Heparin Assay)","PX-LH300542","CDM",85520,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.27,39.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Renin Plasma Ref","PX-LH300543","CDM",84244,"CPT",300,"RC",{"$nulls":6},"both",null,null,172,172,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mycobacteria D-Probe Ref Infectious Agent Detection by Nucleic Acid (Dna or Rna)","PX-LH300544","CDM",87556,"CPT",300,"RC",{"$nulls":6},"both",null,null,125.04,125.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cyclic Amp(Urine) Ref","PX-LH300545","CDM",82030,"CPT",300,"RC",{"$nulls":6},"both",null,null,77.4,77.4,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bilirubin Panel","PX-LH300546","CDM",82248,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C1 Esterance Ref","PX-LH300547","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C2 Ref","PX-LH300548","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Group B Strep-Vag & Anal","PX-LH300549","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza A","PX-LH300550","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza B","PX-LH300551","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tissue Transglutaminase Quantitative Nos","PX-LH300552","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acid Hemolysis (Ham Test)","PX-LH300553","CDM",85475,"CPT",300,"RC",{"$nulls":6},"both",null,null,26.61,26.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cryptosperidium Stool Ref","PX-LH300554","CDM",87272,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Typhus Antibody Ref","PX-LH300555","CDM",86000,"CPT",300,"RC",{"$nulls":6},"both",null,null,20.94,20.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza a - Walhalla Clinic","PX-LH300556","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza B Walhalla Clinic","PX-LH300557","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Parietal Cell Antibody Ref.","PX-LH300558","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Salmonella Total Ab Ref","PX-LH300559","CDM",86768,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.57,39.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hemosiderin Qualitative Ua Ref","PX-LH300560","CDM",83070,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Prealbumin Ref.","PX-LH300561","CDM",84134,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Reticulin Antibody Ref","PX-LH300562","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Oxcarbazepine Ref","PX-LH300564","CDM",80183,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.75,39.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acth Plasma Ref","PX-LH300565","CDM",82024,"CPT",300,"RC",{"$nulls":6},"both",null,null,299,299,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Wbc & Diff Fluid Ref","PX-LH300566","CDM",89051,"CPT",300,"RC",{"$nulls":6},"both",null,null,42,42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Glucose, Fluid Excl Blood Ref","PX-LH300567","CDM",82945,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti Ssa/Ro Ref","PX-LH300568","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti Ssb/La Ref","PX-LH300569","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cystology Fluid Excl Cerv/Vag Reference","PX-LH300570","CDM",88104,"CPT",300,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Herpes Type 1 & 2 Igm Ref","PX-LH300571","CDM",86695,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.57,39.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lead 24hr US Ref.","PX-LH300572","CDM",83655,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcv Rna Ref","PX-LH300573","CDM",87521,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcv Genotyping Ref","PX-LH300574","CDM",87902,"CPT",300,"RC",{"$nulls":6},"both",null,null,772.35,772.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcv Viral Load Ref","PX-LH300575","CDM",87522,"CPT",300,"RC",{"$nulls":6},"both",null,null,332,332,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Micro Ua Walhalla Clinic","PX-LH300577","CDM",81015,"CPT",300,"RC",{"$nulls":6},"both",null,null,9.15,9.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Copper 24hr Ua Ref","PX-LH300578","CDM",82525,"CPT",300,"RC",{"$nulls":6},"both",null,null,100,100,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Total Protien Ua, Random Ref Serum, Plasma, or Whole Blood","PX-LH300579","CDM",84155,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Creatinine Ua, Random Ref","PX-LH300580","CDM",82570,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Creatine Urine Ref.","PX-LH300581","CDM",82540,"CPT",300,"RC",{"$nulls":6},"both",null,null,13.92,13.92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Screening Occult Blood Feces Colrctl Ca 1-3 Cards","PX-LH300582","CDM",82270,"CPT",300,"RC",{"$nulls":6},"both",null,null,13.14,13.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Urovision Ref.","PX-LH300584","CDM",88271,"CPT",300,"RC",{"$nulls":6},"both",null,null,64.26,64.26,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Serotonin Serum Ref","PX-LH300585","CDM",84260,"CPT",300,"RC",{"$nulls":6},"both",null,null,92.94,92.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh C1 Esterace Inhibitor Neph","PX-LH300586","CDM",83883,"CPT",300,"RC",{"$nulls":6},"both",null,null,40.8,40.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Amindeuelinic & Porph. Ref Enzyme Activity Nonradioactive Substrate","PX-LH300587","CDM",82657,"CPT",300,"RC",{"$nulls":6},"both",null,null,66.51,66.51,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ua Micro Walhalla","PX-LH300588","CDM",81015,"CPT",300,"RC",{"$nulls":6},"both",null,null,9.15,9.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chlamydia Pneunoniae Igm Antibdy Ref","PX-LH300589","CDM",86632,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.04,38.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bk Polumd Virus Dna/Rna Amp Ref","PX-LH300591","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ttg-Iga,Igg Ref","PX-LH300592","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antiglomerculu Basement Membrane Re Quantitative Nos","PX-LH300593","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh West Nile Virus Ab Igg","PX-LH300594","CDM",86789,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cmv Antigenemia Assay Ref","PX-LH300595","CDM",86644,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bordetella Pertussis/Pcr Amp Ref","PX-LH300596","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bnp","PX-LH300597","CDM",83880,"CPT",300,"RC",{"$nulls":6},"both",null,null,263,263,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lamotrigine Ref","PX-LH300598","CDM",80175,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Scabies Ref","PX-LH300599","CDM",87220,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Extractable Antigen Sm/Rnp Ref","PX-LH300600","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Jo-1 Antibody Ref","PX-LH300601","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Scleroderma Anitbody Scl-70 Ref","PX-LH300602","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisone Ref Mass Spectometry","PX-LH300603","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T3 Total Ref","PX-LH300604","CDM",84480,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Copper Serum, Ref","PX-LH300605","CDM",82525,"CPT",300,"RC",{"$nulls":6},"both",null,null,100,100,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bun Body Fluid Quant Ref","PX-LH300606","CDM",84520,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Creatinine Body Fluid Ref","PX-LH300607","CDM",82570,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin E Ref","PX-LH300608","CDM",84446,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Herpes Pcr Dna Amp Ref","PX-LH300609","CDM",87529,"CPT",300,"RC",{"$nulls":6},"both",null,null,269,269,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aluminum Ref","PX-LH300610","CDM",82108,"CPT",300,"RC",{"$nulls":6},"both",null,null,76.44,76.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alk Phos Isoenzyme Ref","PX-LH300611","CDM",84080,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti Lkm-1 Ref","PX-LH300612","CDM",86376,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Helicobacter Pylori Stool Ref","PX-LH300613","CDM",87338,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Carbamazepine Free Reff","PX-LH300614","CDM",80156,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.71,43.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ticihomonas Culture Vaginal Ref","PX-LH300615","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cyclic Citrillinated Peptide Ref","PX-LH300616","CDM",86200,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cold Hemagglutinins Titer Ref","PX-LH300617","CDM",86157,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.18,24.18,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh RBC, Folate Ref","PX-LH300618","CDM",82747,"CPT",300,"RC",{"$nulls":6},"both",null,null,52.95,52.95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Benzodiazepine Panel Ref 1-12","PX-LH300619","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Measles Antibody Igg Ref","PX-LH300620","CDM",86765,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fasttsh","PX-LH300621","CDM",84443,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Biointact Pth Ref","PX-LH300622","CDM",82310,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Serum Oxlate(Oxalic Acid) Ref","PX-LH300623","CDM",83945,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alpha 1 Anti Qn Ref","PX-LH300624","CDM",82103,"CPT",300,"RC",{"$nulls":6},"both",null,null,104,104,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Tbhcg2 Quant","PX-LH300625","CDM",84702,"CPT",300,"RC",{"$nulls":6},"both",null,null,119,119,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ld Iso Enzyme Ref","PX-LH300626","CDM",83625,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.37,38.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetyl Choline Ref","PX-LH300627","CDM",84238,"CPT",300,"RC",{"$nulls":6},"both",null,null,109.71,109.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fructosamine Ref","PX-LH300628","CDM",82985,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin B1 (Thiamine) Ref","PX-LH300630","CDM",84425,"CPT",300,"RC",{"$nulls":6},"both",null,null,157,157,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Zinc Ref","PX-LH300631","CDM",84630,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fdp-Fibinogen Degration Products Agglut Sld Semiquant Ref","PX-LH300632","CDM",85362,"CPT",300,"RC",{"$nulls":6},"both",null,null,20.67,20.67,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rsv Dfa Serum Ref","PX-LH300633","CDM",87280,"CPT",300,"RC",{"$nulls":6},"both",null,null,40.24,40.24,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Manganese Ref","PX-LH300634","CDM",83785,"CPT",300,"RC",{"$nulls":6},"both",null,null,79.95,79.95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Chromium Ref","PX-LH300635","CDM",82495,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.84,60.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cadmium Ref","PX-LH300636","CDM",82300,"CPT",300,"RC",{"$nulls":6},"both",null,null,173,173,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antiphospholipid Panel Ref","PX-LH300637","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hcg Serum Qualitative Ref","PX-LH300638","CDM",84703,"CPT",300,"RC",{"$nulls":6},"both",null,null,59,59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rsv Swab","PX-LH300639","CDM",87807,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Blood Type Ag,Each","PX-LH300640","CDM",86902,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.05,19.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cd-4 Cell Count Ref","PX-LH300641","CDM",86361,"CPT",300,"RC",{"$nulls":6},"both",null,null,80.34,80.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Keppra(Levetiracetam) Ref","PX-LH300642","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Myasthenia Gravis Panel 2 Ref","PX-LH300643","CDM",84238,"CPT",300,"RC",{"$nulls":6},"both",null,null,109.71,109.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hpv Typing Dna Ref","PX-LH300644","CDM",87999,"CPT",300,"RC",{"$nulls":6},"both",null,null,218.8,218.8,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis D Igm Ref","PX-LH300645","CDM",86692,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.48,51.48,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis E Igg Ref","PX-LH300646","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis E Igm Ref","PX-LH300647","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nicotine(Cotinine) Ref","PX-LH300648","CDM",80323,"CPT",300,"RC",{"$nulls":6},"both",null,null,183,183,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cmv Quant Ref","PX-LH300649","CDM",87497,"CPT",300,"RC",{"$nulls":6},"both",null,null,343,343,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Wbc CSF","PX-LH300650","CDM",85032,"CPT",300,"RC",{"$nulls":6},"both",null,null,12.93,12.93,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh RBC Manual CSF","PX-LH300651","CDM",85032,"CPT",300,"RC",{"$nulls":6},"both",null,null,12.93,12.93,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Glucose CSF","PX-LH300652","CDM",82945,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Total Protein Electro CSF","PX-LH300653","CDM",84166,"CPT",300,"RC",{"$nulls":6},"both",null,null,144,144,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ldh CSF","PX-LH300654","CDM",83615,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Compelment C5 Ref","PX-LH300655","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisol Total Salivary Ref","PX-LH300656","CDM",82533,"CPT",300,"RC",{"$nulls":6},"both",null,null,128,128,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Carnitire Ref","PX-LH300657","CDM",82379,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.61,50.61,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lactic Acid","PX-LH300658","CDM",83605,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pyridoine Pyridoxal Vit B6 Ref","PX-LH300659","CDM",84207,"CPT",300,"RC",{"$nulls":6},"both",null,null,218,218,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sensory Neuropathy Profile Ref","PX-LH300660","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alpha 1-Antitryspin Pheno Serum","PX-LH300661","CDM",82104,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.38,43.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Co-71 Soluble Transferrin Rec Ref","PX-LH300662","CDM",84238,"CPT",300,"RC",{"$nulls":6},"both",null,null,109.71,109.71,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vancomycin Trough Ref","PX-LH300663","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vancomycin Peak Ref","PX-LH300664","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Jak2 Mutation Ref","PX-LH300665","CDM",81270,"CPT",300,"RC",{"$nulls":6},"both",null,null,458,458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aceto Acetic Acid Quant Ref","PX-LH300666","CDM",82010,"CPT",300,"RC",{"$nulls":6},"both",null,null,63,63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Beta-Hydro-Butyr Quant Ref","PX-LH300667","CDM",82010,"CPT",300,"RC",{"$nulls":6},"both",null,null,63,63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Legionella Pneumohplia Serum Ref","PX-LH300668","CDM",86713,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.9,45.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Parvovirus B19 Ab","PX-LH300669","CDM",86747,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.09,45.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti-Hu Ab West Blot Ref","PX-LH300670","CDM",84181,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.09,51.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pm-Sci Antibodies Ref","PX-LH300671","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pneumoccal Ag Ua Ref","PX-LH300672","CDM",86403,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.62,34.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Inhibin a Ref","PX-LH300673","CDM",86336,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh CCP Antibody Ref","PX-LH300674","CDM",86200,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergy Test Eggs Ref","PX-LH300675","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergy Egg White Ref","PX-LH300676","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Herpes Type II Ref","PX-LH300677","CDM",86696,"CPT",300,"RC",{"$nulls":6},"both",null,null,58.05,58.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Von Willebrand Factor Panel Ref Thromboplastin Time Partial (Ptt) Plasma or Whole Blood","PX-LH300678","CDM",85730,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin D 1,25 Di Hydro Ref","PX-LH300679","CDM",82652,"CPT",300,"RC",{"$nulls":6},"both",null,null,297,297,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin B 6 Ref","PX-LH300680","CDM",84207,"CPT",300,"RC",{"$nulls":6},"both",null,null,218,218,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor VIII (8) Ref","PX-LH300681","CDM",85240,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Factor X (10) Ref","PX-LH300682","CDM",85260,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-8 (Cardic)","PX-LH300683","CDM",84484,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Venipuncture","PX-LH300684","CDM",36415,"CPT",300,"RC",{"$nulls":6},"both",null,null,30.5,30.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Inflammatory Bowel Disease Ref","PX-LH300685","CDM",86671,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T- Protein Fluid Ref","PX-LH300686","CDM",84157,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ldh Fluid Ref","PX-LH300688","CDM","LH300688","LOCAL",300,"RC",{"$nulls":6},"both",null,null,91,91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Thrombosis Panel Protein C Activity Ref","PX-LH300689","CDM",85303,"CPT",300,"RC",{"$nulls":6},"both",null,null,108,108,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ketones Serum Quant Ref","PX-LH300690","CDM",82010,"CPT",300,"RC",{"$nulls":6},"both",null,null,63,63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ana Profile Ref","PX-LH300691","CDM",86038,"CPT",300,"RC",{"$nulls":6},"both",null,null,96,96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Sulfate Ua Ref","PX-LH300692","CDM",84392,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alcohol Breath Dot","PX-LH300693","CDM",82075,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Iga Subclasses Ref","PX-LH300694","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Proteinase-3 Antibody Ref","PX-LH300695","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Protime Inr WC","PX-LH300696","CDM",85610,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mthfr Ref","PX-LH300697","CDM",81270,"CPT",300,"RC",{"$nulls":6},"both",null,null,458,458,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bca X 2 Ref","PX-LH300698","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bcan X 3 Ref","PX-LH300699","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bca X 2 Ref","PX-LH300700","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bcan X 3 Ref","PX-LH300701","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Gentamicin Peak Ref","PX-LH300702","CDM",80170,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.14,49.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Lysozyme Serum Ref","PX-LH300703","CDM",85549,"CPT",300,"RC",{"$nulls":6},"both",null,null,56.25,56.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Drug Screen 10 - Medicare","PX-LH300704","CDM","G0481","CPT",300,"RC",{"$nulls":6},"both",null,null,469.77,469.77,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Myeloperoxidase Ab Ref","PX-LH300705","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergy Meadow Grass Ref","PX-LH300706","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergy Rye Grass Ref","PX-LH300707","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergy Wheat Ref","PX-LH300708","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebv Virus Panel Ref Nucl Ag","PX-LH300709","CDM",86664,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Resp Allergy Profile Ref Quantitative","PX-LH300710","CDM",82785,"CPT",300,"RC",{"$nulls":6},"both",null,null,129,129,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Igd Ref","PX-LH300711","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Igg Latex Ref","PX-LH300712","CDM",86001,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Fis Bcr/Abl Ref","PX-LH300713","CDM",88271,"CPT",300,"RC",{"$nulls":6},"both",null,null,64.26,64.26,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Growth Hormone Ref","PX-LH300714","CDM",83003,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.01,50.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Toxoplasma Antibodies Ref","PX-LH300715","CDM",86777,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Babesia Ab","PX-LH300716","CDM",86753,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anaplasma Phagocytophilum Ref","PX-LH300717","CDM",86666,"CPT",300,"RC",{"$nulls":6},"both",null,null,79,79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mygolobin Serum Ref","PX-LH300718","CDM",83874,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.76,38.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cardio Crp Ref","PX-LH300719","CDM",86141,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Reverse T3 Ref","PX-LH300720","CDM",84482,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rast(Milk Allergy) Ref","PX-LH300721","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ldl","PX-LH300722","CDM",83721,"CPT",300,"RC",{"$nulls":6},"both",null,null,75,75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Norwalk Virus Ref","PX-LH300723","CDM",87449,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Microalbumin, Urine Quant","PX-LH300724","CDM",82043,"CPT",300,"RC",{"$nulls":6},"both",null,null,17.34,17.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Albumin Fluid Ref","PX-LH300725","CDM",82042,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.34,23.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Reduce Substance Stool Ref","PX-LH300726","CDM",84376,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.5,16.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-10(Chol/Ldl)","PX-LH300727","CDM",82465,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-11(Hdl/Ldl)","PX-LH300728","CDM",83718,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.57,24.57,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-12(Trig/Ldl)","PX-LH300729","CDM",84478,"CPT",300,"RC",{"$nulls":6},"both",null,null,46,46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Buprenorphine Ref","PX-LH300730","CDM",80348,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vasopressin Ref","PX-LH300731","CDM",84588,"CPT",300,"RC",{"$nulls":6},"both",null,null,101.82,101.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rast(Bermud. Grass) Ref","PX-LH300732","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rast (Timothy Grass) Ref","PX-LH300733","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rast (House Dust H1) Ref","PX-LH300734","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rast (House Dust H2) Ref","PX-LH300735","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Rocky Mountain Sf(Spotted Fever)","PX-LH300736","CDM",86757,"CPT",300,"RC",{"$nulls":6},"both",null,null,58.05,58.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Srp Auto Antibody Ref","PX-LH300737","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mi-2 Auto Antibody Ref","PX-LH300738","CDM","LH300738","LOCAL",300,"RC",{"$nulls":6},"both",null,null,175,175,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Dexa Surprression Sngl Dose Ref","PX-LH300739","CDM",82533,"CPT",300,"RC",{"$nulls":6},"both",null,null,128,128,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Beta 2-Gly Pro Anti Ref","PX-LH300742","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Uric Acid Crystals Oth Source Ref","PX-LH300743","CDM",84560,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin a(Retinol) Ref","PX-LH300744","CDM",84590,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.83,34.83,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Vitamin B2 (Riboflavin) Ref","PX-LH300745","CDM",84252,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.72,60.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Blood Count; Hemoglobin","PX-LH300746","CDM",85018,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Strawberry Ige Ref","PX-LH300752","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Testesterone Bio Ref","PX-LH300776","CDM",82040,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nucleic Acid, High Resolute Amp","PX-LH700005","CDM",87801,"CPT",300,"RC",{"$nulls":6},"both",null,null,210.6,210.6,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Trachea Care","PX-LH202465","CDM","LH202465","LOCAL",270,"RC",{"$nulls":6},"both",null,null,8.64,8.64,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Doppler Upper Ext,Arteries","PX-9210028","CDM",93890,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Inguinal Hernia","PX-LH4400830","CDM",830,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Iridectomy","PX-LH4400147","CDM",147,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Physician E&M Visit,Trmt Room","PX-LH62212","CDM",99212,"CPT",761,"RC",{"$nulls":6},"both",null,null,70.86,70.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Closed Tx Radial&Ulnar Shaft Fractures W/O Mnpj","PX-25560","CDM",25560,"CPT",982,"RC",{"$nulls":6},"both",null,null,865.89,865.89,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},258.8,290.89,null,null,"facility"]
["LEUPROLIDE ACETATE 7.5 MG IM KIT","RX-10392","CDM","J9217","HCPCS",636,"RC","00074-3642-03","NDC",{"$nulls":4},"both",7.5,"ME",2805.5,2805.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NICOTINE POLACRILEX 2 MG MT GUM","RX-10717","CDM",6370005,"HCPCS",250,"RC","00113-0456-60","NDC",{"$nulls":4},"both",1,"UN",6.75,6.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ALIGN 4 MG PO CAPS","RX-111797","CDM",6370005,"HCPCS",250,"RC","37000-0143-43","NDC",{"$nulls":4},"both",1,"UN",4.25,4.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["SIMVASTATIN 40 MG PO TABS","RX-11366","CDM",6370005,"HCPCS",250,"RC","60687-0210-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","RX-124650","CDM","J2710","HCPCS",636,"RC","63323-0415-10","NDC",{"$nulls":4},"both",10,"ML",225.75,225.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["TOBRAMYCIN 0.3 % OP SOLN","RX-127425","CDM",2500005,"HCPCS",250,"RC","62332-0518-05","NDC",{"$nulls":4},"both",5,"ML",30.25,30.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["VERAPAMIL HCL ER 120 MG PO TBCR","RX-13184","CDM",6370005,"HCPCS",250,"RC","68462-0292-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["USTEKINUMAB 130 MG/26ML IV SOLN","RX-137602","CDM","J3358","HCPCS",636,"RC","57894-0054-27","NDC",{"$nulls":4},"both",130,"ME",2829.25,2829.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY","RX-144873","CDM","J2426","HCPCS",636,"RC","50458-0562-01","NDC",{"$nulls":4},"both",0.75,"ML",2481.25,2481.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","RX-148387","CDM",6370005,"HCPCS",250,"RC","68094-0129-62","NDC",{"$nulls":4},"both",15,"ML",14.5,14.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY","RX-153454","CDM","J0561","HCPCS",636,"RC","60793-0701-10","NDC",{"$nulls":4},"both",2,"ML",739.25,739.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["TRIPLE ANTIBIOTIC 5-400-5000 MG-UNIT EX OINT","RX-155859","CDM",2500006,"HCPCS",250,"RC","00713-0268-31","NDC",{"$nulls":4},"both",28.4,"GR",12,12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["BUPROPION HCL ER (SR) 150 MG PO TB12","RX-18386","CDM",6370005,"HCPCS",250,"RC","50090-0861-00","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["AZITHROMYCIN 500 MG IV SOLR","RX-21063","CDM","J0456","HCPCS",636,"RC","70095-0025-01","NDC",{"$nulls":4},"both",500,"ME",23,23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["DIAZEPAM 5 MG PO TABS","RX-2405","CDM",6370005,"HCPCS",250,"RC","51079-0285-20","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NITROGLYCERIN 0.4 MG/HR TD PT24","RX-27474","CDM",6370005,"HCPCS",250,"RC","00378-9112-93","NDC",{"$nulls":4},"both",1,"UN",7.75,7.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["SODIUM CHLORIDE 0.9 % IV SOLN","RX-27838","CDM","J7050","HCPCS",258,"RC","00338-0049-02","NDC",{"$nulls":4},"both",250,"ML",53.5,53.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["FLEET PEDIATRIC 3.5-9.5 GM/59ML REC ENEM","RX-3128","CDM",6370005,"HCPCS",250,"RC","00132-0202-20","NDC",{"$nulls":4},"both",1,"UN",9.5,9.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["GEMFIBROZIL 600 MG PO TABS","RX-3378","CDM",6370005,"HCPCS",250,"RC","60687-0224-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HYDROCORTISONE ACETATE 25 MG REC SUPP","RX-3738","CDM",6370005,"HCPCS",250,"RC","16571-0676-21","NDC",{"$nulls":4},"both",1,"UN",11.25,11.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["IPRATROPIUM BROMIDE HFA 17 MCG/ACT IN AERS","RX-41142","CDM",2500006,"HCPCS",250,"RC","00597-0087-17","NDC",{"$nulls":4},"both",12.9,"GR",394.75,394.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["LISINOPRIL 20 MG PO TABS","RX-4526","CDM",6370005,"HCPCS",250,"RC","00904-6799-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["NITROFURANTOIN MACROCRYSTAL 100 MG PO CAPS","RX-5593","CDM",6370005,"HCPCS",250,"RC","70756-0412-11","NDC",{"$nulls":4},"both",1,"UN",5.5,5.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["SODIUM CHLORIDE FLUSH 0.9 % IV SOLN STERILE FIELD","RX-600535","CDM",2500006,"HCPCS",250,"RC","08290-3065-53","NDC",{"$nulls":4},"both",10,"ML",20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["PROMETHAZINE HCL 25 MG/ML INJ SOLN","RX-6618","CDM","J2550","HCPCS",636,"RC","00641-6208-25","NDC",{"$nulls":4},"both",1,"ML",23,23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["SODIUM BICARBONATE 650 MG PO TABS","RX-7313","CDM",6370005,"HCPCS",250,"RC","00904-7261-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CARBOXYMETHYLCELLUL-GLYCERIN 0.5-0.9 % OP SOLN","RX-81857","CDM",6370005,"HCPCS",250,"RC","00023-6630-10","NDC",{"$nulls":4},"both",10,"ML",44,44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["ACYCLOVIR 5 % EX OINT","RX-8968","CDM",6370005,"HCPCS",250,"RC","65162-0835-94","NDC",{"$nulls":4},"both",15,"GR",79,79,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["VENLAFAXINE HCL ER 150 MG PO TB24","RX-94157","CDM",2500006,"HCPCS",250,"RC","29033-0045-30","NDC",{"$nulls":4},"both",1,"UN",26.75,26.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CEFTRIAXONE SODIUM 1 G INJ SOLR","RX-9487","CDM","J0696","HCPCS",636,"RC","00409-7332-11","NDC",{"$nulls":4},"both",1,"GR",23,23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Surgical Path-Level VI","PX-401536087","CDM",88309,"CPT",312,"RC",{"$nulls":6},"both",null,null,2457.87,2457.87,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Inject Si Joint Arthrgrphy&/Anes/Steroid W/Ima","PX-27096","CDM",27096,"CPT",982,"RC",{"$nulls":6},"both",null,null,475.8,475.8,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},78.66,159.21,null,null,"facility"]
["Closed Tx Ankle Dislocation W/O Anesthesia","PX-27840","CDM",27840,"CPT",982,"RC",{"$nulls":6},"both",null,null,1119.9,1119.9,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},377.59,377.59,null,null,"facility"]
["Lh Cocaine","PX-LH300833","CDM",80353,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Intubation Endotracheal Emergency Procedure","PX-31500","CDM",31500,"CPT",982,"RC",{"$nulls":6},"both",null,null,383.52,383.52,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},129.74,129.74,null,null,"facility"]
["HC Inj Paravert F Jnt C/T 1 Lev","PX-4903053","CDM",64490,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Ag Class I (E,K)","PX-LH300810","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Chemodenervation 1 Extremity Ea Addl 1-4 Muscle","PX-64643","CDM",64643,"CPT",975,"RC",{"$nulls":6},"both",null,null,261.45,261.45,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},64.64,88.22,null,null,"facility"]
["Lh Tpmt Activity Mass Spectometry","PX-LH300822","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Colectomy Prtl W/Coloproctostomy","PX-44145","CDM",44145,"CPT",975,"RC",{"$nulls":6},"both",null,null,4462.86,4462.86,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},1514.72,1514.72,null,null,"facility"]
["Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn","PX-62323","CDM",62323,"CPT",975,"RC",{"$nulls":6},"both",null,null,751.35,751.35,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},94.08,251.25,null,null,"facility"]
["Lh Strep Group B Antigen","PX-LH300876","CDM",86403,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.62,34.62,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Quantiferon TB Fold","PX-LH300892","CDM",86480,"CPT",300,"RC",{"$nulls":6},"both",null,null,504,504,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh C.Diff-Ia","PX-LH300967","CDM",87449,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Organic Acids Qual,Urine","PX-LH300991","CDM",83919,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.35,49.35,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Incisional Bx Addl Skin Lesion","PX-4903282","CDM",11107,"CPT",761,"RC",{"$nulls":6},"both",null,null,450.84,450.84,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Candida Species,Direct Probe","PX-LH301014","CDM",87480,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Posaconazole","PX-LH301032","CDM",80187,"CPT",300,"RC",{"$nulls":6},"both",null,null,81.33,81.33,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Genicular Nrv Branches W/Img","PX-64454","CDM",64454,"CPT",975,"RC",{"$nulls":6},"both",null,null,645.72,645.72,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},78.01,215.86,null,null,"facility"]
["HC Cdsm Ndsc","PX-3201004","CDM","G1004","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Aspergillus Antigen,Eia,Serum","PX-LH301064","CDM",87305,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Ext Ecg >7d<15d Recording","PX-7310017","CDM",93246,"CPT",360,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn","PX-94060","CDM",94060,"CPT",982,"RC",{"$nulls":6},"both",null,null,113.73,113.73,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},9.67,37.99,null,null,"facility"]
["Lh Respiratory Syncytial Virus","PX-LH87634","CDM",87634,"CPT",300,"RC",{"$nulls":6},"both",null,null,210.6,210.6,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Emergency Department Visit May Not Req Phys/Qhp","PX-99281","CDM",99281,"CPT",981,"RC",{"$nulls":6},"both",null,null,31.59,31.59,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},10.66,10.66,null,null,"facility"]
["Lh Chemiluminescent Assay","PX-LH82397","CDM",82397,"CPT",300,"RC",{"$nulls":6},"both",null,null,42.36,42.36,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Xr-Mandible 4+ Views","PX-3200228","CDM",70110,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Xr-Spine Single View","PX-3200232","CDM",72020,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Xray Elbow","PX-3200048","CDM",73070,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Bone Survey Complete","PX-3200215","CDM",77075,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500002","CDM",70492,"CPT",350,"RC",{"$nulls":6},"both",null,null,2070,2070,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CT-Facial Bone","PX-3510006","CDM",70486,"CPT",350,"RC",{"$nulls":6},"both",null,null,723.56,723.56,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520009","CDM",74170,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Prostate Transrectal","PX-4020027","CDM",76872,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC S I Techniques 15 Min","PX-4300017","CDM",97533,"CPT",430,"RC",{"$nulls":6},"both",null,null,183.09,183.09,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Closed Rx Mt-Phal Toe Dislocation","PX-4500041","CDM",28630,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CPR","PX-4500092","CDM",92950,"CPT",360,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Spirometry","PX-4600000","CDM",94010,"CPT",460,"RC",{"$nulls":6},"both",null,null,446.49,446.49,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Shav Skin Les <5mm Trunk,Arm,Leg","PX-4900030","CDM",11300,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Remaindr Bod","PX-4900050","CDM",11422,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Complic","PX-4900095","CDM",11772,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 12.6-20","PX-4900129","CDM",12045,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Destroy Premlg Lesions 15+","PX-4900241","CDM",17004,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Closed Rx Navicular Fx","PX-4900580","CDM",25622,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Remove Foot Lesion Sngl Ea","PX-4900876","CDM",28080,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Part Removal of Foot Bone","PX-4900914","CDM",28288,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Remove Anal Fistula Subcut","PX-4902165","CDM",46270,"CPT",360,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Incision & Removal Foreign Body Subq Tiss Simple","PX-10120","CDM",10120,"CPT",982,"RC",{"$nulls":6},"both",null,null,441.78,441.78,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},102.08,147.92,null,null,"facility"]
["HC Spinal Puncture,Therapeutic","PX-4901629","CDM",62272,"CPT",450,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm","PX-11401","CDM",11401,"CPT",982,"RC",{"$nulls":6},"both",null,null,452.97,452.97,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},101.92,151.69,null,null,"facility"]
["Yag Laser","PX-4901775","CDM",66821,"CPT",360,"RC",{"$nulls":6},"both",null,null,1661.49,1661.49,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Excis Chalazion,Single","PX-4901818","CDM",67800,"CPT",360,"RC",{"$nulls":6},"both",null,null,832.68,832.68,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",982,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},296,427.96,null,null,"facility"]
["MRI Lower Extremity","PX-6100024","CDM",73718,"CPT",610,"RC",{"$nulls":6},"both",null,null,3020,3020,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Pacu/IP Min","PX-7100001","CDM",null,null,710,"RC",{"$nulls":6},"both",null,null,1800,1800,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500036","CDM",45384,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["IV Push","PX-9400011","CDM",96374,"CPT",260,"RC",{"$nulls":6},"both",null,null,632.07,632.07,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Simple Repair F/E/E/N/L/M 2.5cm/<","PX-12011","CDM",12011,"CPT",982,"RC",{"$nulls":6},"both",null,null,319.29,319.29,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},51.03,107.35,null,null,"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.5cm/<","PX-12041","CDM",12041,"CPT",982,"RC",{"$nulls":6},"both",null,null,763.2,763.2,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},138.33,255.55,null,null,"facility"]
["Adjt Tis Trnsfr/Reargmt Scalp/Arm/Leg 10 Sq Cm/<","PX-14020","CDM",14020,"CPT",982,"RC",{"$nulls":6},"both",null,null,2022.72,2022.72,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},542.01,678.88,null,null,"facility"]
["Destruction Benign Lesions Up to 14","PX-17110","CDM",17110,"CPT",982,"RC",{"$nulls":6},"both",null,null,332.7,332.7,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},66.67,94.53,null,null,"facility"]
["Lh Esr Auto","PX-LH300006","CDM",85652,"CPT",300,"RC",{"$nulls":6},"both",null,null,21,21,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh CK (Crea Kinase) Total","PX-LH300029","CDM",82550,"CPT",300,"RC",{"$nulls":6},"both",null,null,50,50,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Culture N/P Ref","PX-LH300052","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Culture Vaginal Ref","PX-LH300060","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Bld Type Rh","PX-LH300094","CDM",86901,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.25,39.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Cortisol Total-Serum","PX-LH300152","CDM",82533,"CPT",300,"RC",{"$nulls":6},"both",null,null,128,128,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Fsh Ref","PX-LH300175","CDM",83001,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Ibc","PX-LH300198","CDM",83550,"CPT",300,"RC",{"$nulls":6},"both",null,null,72,72,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Antigranulocyte Ab Ref","PX-LH300301","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tegretol Total","PX-LH300349","CDM",80156,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.71,43.71,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Valproic Acid Ref Total","PX-LH300361","CDM",80164,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Thyroid Peroxid","PX-LH300383","CDM",86376,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Cryoglobulins Qual/Semi-Quant","PX-LH300405","CDM",82595,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.41,19.41,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Rapid Strep WC","PX-LH300439","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Gliadin Ab, Igg","PX-LH300463","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Protein C Activity Ref","PX-LH300487","CDM",85303,"CPT",300,"RC",{"$nulls":6},"both",null,null,108,108,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Ua-Micro","PX-LH300517","CDM",81015,"CPT",300,"RC",{"$nulls":6},"both",null,null,9.15,9.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Psa Hyb, Total Diagnostic","PX-LH300521","CDM",84153,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Influenza a - Walhalla Clinic","PX-LH300556","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Creatinine Ua, Random Ref","PX-LH300580","CDM",82570,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh T3 Total Ref","PX-LH300604","CDM",84480,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Ticihomonas Culture Vaginal Ref","PX-LH300615","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Alpha 1-Antitryspin Pheno Serum","PX-LH300661","CDM",82104,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.38,43.38,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Pro-8 (Cardic)","PX-LH300683","CDM",84484,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Proteinase-3 Antibody Ref","PX-LH300695","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Anaplasma Phagocytophilum Ref","PX-LH300717","CDM",86666,"CPT",300,"RC",{"$nulls":6},"both",null,null,79,79,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh TB Gold Ref","PX-LH300755","CDM",86480,"CPT",300,"RC",{"$nulls":6},"both",null,null,504,504,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh C-Diff Dna-Pcr Ref","PX-LH300777","CDM",87493,"CPT",300,"RC",{"$nulls":6},"both",null,null,269,269,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Immunhistochemistry Init Sngl Ab Stn","PX-LH700006","CDM",88342,"CPT",300,"RC",{"$nulls":6},"both",null,null,514.08,514.08,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Pacemaker and Lead Wire Kit","PX-LH201670","CDM","LH201670","LOCAL",270,"RC",{"$nulls":6},"both",null,null,216.09,216.09,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tegaderm","PX-LH202360","CDM","LH202360","LOCAL",270,"RC",{"$nulls":6},"both",null,null,5.25,5.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Anesthesia Vasectomy Unilat/Bilat","PX-LH4400921","CDM",921,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Anesthesia Iridectomy","PX-LH4400147","CDM",147,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Physician E&M Visit,Trmt Room","PX-LH62212","CDM",99212,"CPT",761,"RC",{"$nulls":6},"both",null,null,70.86,70.86,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Airway Inhalation Trmt Subsq","PX-4100018","CDM",94640,"CPT",410,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Closed Tx Radial Shaft Fracture W/O Manipulation","PX-25500","CDM",25500,"CPT",982,"RC",{"$nulls":6},"both",null,null,849.81,849.81,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},257.65,285.48,null,null,"facility"]
["NICOTINE POLACRILEX 2 MG MT GUM","RX-10717","CDM",6370005,"HCPCS",250,"RC","00113-0456-60","NDC",{"$nulls":4},"both",1,"UN",6.75,6.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","RX-108872","CDM",2500006,"HCPCS",250,"RC","61314-0631-36","NDC",{"$nulls":4},"both",3.5,"GR",67.25,67.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["ERTAPENEM SODIUM 1 G INJ SOLR","RX-111716","CDM","J1335","HCPCS",636,"RC","55150-0282-20","NDC",{"$nulls":4},"both",1,"GR",102.75,102.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["PHYTONADIONE 1 MG/0.5ML INJ SOLN","RX-120964","CDM","J3430","HCPCS",636,"RC","76329-1240-01","NDC",{"$nulls":4},"both",0.5,"ML",48.25,48.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["INSULIN ASPART 100 UNIT/ML SC SOPN","RX-127449","CDM","J1815","HCPCS",636,"RC","73070-0103-10","NDC",{"$nulls":4},"both",3,"ML",102,102,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CHLORPROMAZINE HCL 50 MG/2ML INJ SOLN","RX-133100","CDM",6360005,"HCPCS",636,"RC","00641-1398-35","NDC",{"$nulls":4},"both",2,"ML",44,44,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","RX-133644","CDM",6370005,"HCPCS",250,"RC","00054-0088-26","NDC",{"$nulls":4},"both",1,"UN",14.75,14.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["LEVONORGESTREL 19.5 MG IU IUD","RX-137553","CDM","J7296","HCPCS",636,"RC","50419-0424-01","NDC",{"$nulls":4},"both",20,"ME",5819.25,5819.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["MIDAZOLAM HCL (PF) 10 MG/2ML INJ SOLN","RX-146236","CDM","J2250","HCPCS",636,"RC","00409-2308-02","NDC",{"$nulls":4},"both",2,"ML",23,23,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["PENICILLIN G BENZATHINE 1200000 UNIT/2ML IM SUSY","RX-153454","CDM","J0561","HCPCS",636,"RC","60793-0701-10","NDC",{"$nulls":4},"both",2,"ML",739.25,739.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["TRIPLE ANTIBIOTIC 5-400-5000 MG-UNIT EX OINT","RX-155859","CDM",2500006,"HCPCS",250,"RC","00713-0268-31","NDC",{"$nulls":4},"both",28.4,"GR",12,12,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["FLEET SALINE ENEMA 7-19 GM/197ML REC ENEM","RX-160285","CDM",2500006,"HCPCS",250,"RC","00132-0201-40","NDC",{"$nulls":4},"both",1,"UN",11,11,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN","RX-18314","CDM","J1250","HCPCS",636,"RC","00409-2346-31","NDC",{"$nulls":4},"both",250,"ML",97.25,97.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CITALOPRAM HYDROBROMIDE 20 MG PO TABS","RX-21062","CDM",6370005,"HCPCS",250,"RC","00378-6232-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","RX-250","CDM","J7613","HCPCS",250,"RC","00487-9501-01","NDC",{"$nulls":4},"both",3,"ML",3.75,3.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["THEOPHYLLINE ER 200 MG PO CP24","RX-27419","CDM",6370005,"HCPCS",250,"RC","52244-0200-10","NDC",{"$nulls":4},"both",1,"UN",12.25,12.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN","RX-29302","CDM","J7510","HCPCS",636,"RC","00121-0759-08","NDC",{"$nulls":4},"both",237,"ML",208.75,208.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["AMOXICILLIN-POT CLAVULANATE ER 1000-62.5 MG PO TB12","RX-33862","CDM",6370005,"HCPCS",250,"RC","00781-1943-82","NDC",{"$nulls":4},"both",1,"UN",28,28,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HYDROMORPHONE HCL 1 MG/ML INJ SOLN","RX-3757","CDM","J1171","HCPCS",636,"RC","00409-1283-31","NDC",{"$nulls":4},"both",1,"ML",23,23,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["PROPRANOLOL HCL ER 80 MG PO CP24","RX-38225","CDM",6370005,"HCPCS",250,"RC","00228-2779-11","NDC",{"$nulls":4},"both",1,"UN",13,13,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["BENZOCAINE-MENTHOL 6-10 MG MT LOZG","RX-41085","CDM",6370005,"HCPCS",250,"RC","78112-0011-06","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CHLOROPROCAINE 2% BUFFERED WITH SOD BICARBONATE INJECTION","RX-452052","CDM","J2400","HCPCS",636,"RC",{"$nulls":6},"both",40,"ML",89.25,89.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["SODIUM CHLORIDE FLUSH 0.9 % IV SOLN STERILE FIELD","RX-600535","CDM",2500006,"HCPCS",250,"RC","08290-3065-53","NDC",{"$nulls":4},"both",10,"ML",20,20,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["PROMETHAZINE HCL 25 MG/ML INJ SOLN","RX-6618","CDM","J2550","HCPCS",636,"RC","00641-6208-25","NDC",{"$nulls":4},"both",1,"ML",23,23,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["BRIMONIDINE TARTRATE 0.1 % OP SOLN","RX-70262","CDM",2500006,"HCPCS",250,"RC","00023-9321-05","NDC",{"$nulls":4},"both",5,"ML",402.75,402.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["SUCCINYLCHOLINE CHLORIDE 20 MG/ML INJ SOLN","RX-7536","CDM","J0330","HCPCS",636,"RC","69918-0700-02","NDC",{"$nulls":4},"both",10,"ML",31.5,31.5,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["GLUCOSE 40 % PO GEL","RX-81823","CDM",6370005,"HCPCS",250,"RC","00574-0069-15","NDC",{"$nulls":4},"both",45,"GR",63.5,63.5,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G INJ SOLR","RX-9084","CDM","J0295","HCPCS",636,"RC","72485-0417-01","NDC",{"$nulls":4},"both",3,"GR",23,23,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CARBIDOPA-LEVODOPA 25-250 MG PO TABS","RX-9408","CDM",6370005,"HCPCS",250,"RC","00378-1133-01","NDC",{"$nulls":4},"both",1,"UN",6.5,6.5,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["ENALAPRIL MALEATE 5 MG PO TABS","RX-9927","CDM",6370005,"HCPCS",250,"RC","23155-0705-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Surgical Path-Level I","PX-401536120","CDM",88300,"CPT",312,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Inject Si Joint Arthrgrphy&/Anes/Steroid W/Ima","PX-27096","CDM",27096,"CPT",982,"RC",{"$nulls":6},"both",null,null,475.8,475.8,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},78.66,159.21,null,null,"facility"]
["Ambulance Non-Emergent","PX-5420012","CDM","A0426","HCPCS",542,"RC",{"$nulls":6},"both",null,null,1009.32,1009.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Cltx Prox Fibula/Shft Fx W/O Manj","PX-27780","CDM",27780,"CPT",982,"RC",{"$nulls":6},"both",null,null,919.08,919.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},283.54,308.75,null,null,"facility"]
["Cltx Tarsal Dislc Oth/Thn Talotarsal W/O Anes","PX-28540","CDM",28540,"CPT",982,"RC",{"$nulls":6},"both",null,null,583.98,583.98,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},175.11,195.41,null,null,"facility"]
["Strapping Elbow/Wrist","PX-29260","CDM",29260,"CPT",982,"RC",{"$nulls":6},"both",null,null,83.64,83.64,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},17.86,28.01,null,null,"facility"]
["Lh Cocaine","PX-LH300833","CDM",80353,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 3+ Level","PX-64492","CDM",64492,"CPT",975,"RC",{"$nulls":6},"both",null,null,1443.02,1443.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},56.71,94.04,null,null,"facility"]
["Tte W/WO Fol W/Con Doppler","PX-4800088","CDM","C8929","HCPCS",483,"RC",{"$nulls":6},"both",null,null,2370.18,2370.18,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Red Cell Pre-Treatment,Each","PX-LH300805","CDM",86970,"CPT",300,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt C/T 2 Lev","PX-4903054","CDM",64491,"CPT",360,"RC",{"$nulls":6},"both",null,null,1548.97,1548.97,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Uro Risk","PX-LH300811","CDM","LH300811","LOCAL",300,"RC",{"$nulls":6},"both",null,null,619,619,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Dexa Scan","PX-3200321","CDM",77081,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Repair Umbilical Lesion","PX-4902649","CDM",49600,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["X-Ray Exam Hip Uni 1 Vw","PX-3200342","CDM",73501,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Calprotectin Stool","PX-LH300849","CDM",83993,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Esophagoscopy Flexible Transoral Diagnostic","PX-43200","CDM",43200,"CPT",975,"RC",{"$nulls":6},"both",null,null,762.69,762.69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},82.31,255.2,null,null,"facility"]
["Egd Dilation Gastric/Duodenal Stricture","PX-43245","CDM",43245,"CPT",975,"RC",{"$nulls":6},"both",null,null,1713.96,1713.96,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},162.98,573.27,null,null,"facility"]
["Lh Prealbumin","PX-LH300870","CDM",84134,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Ot Eval","PX-4340010","CDM",97165,"CPT",430,"RC",{"$nulls":6},"both",null,null,296.19,296.19,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn","PX-62323","CDM",62323,"CPT",975,"RC",{"$nulls":6},"both",null,null,751.35,751.35,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},94.08,251.25,null,null,"facility"]
["Lh Strep Group B Antigen","PX-LH300876","CDM",86403,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.62,34.62,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Stat Therapist Direct Time","PX-8675308","CDM",null,null,9999,"RC",{"$nulls":6},"both",null,null,225,225,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Blastomyces","PX-LH300887","CDM",86612,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.7,38.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Xray Abdomen 1 View","PX-3200360","CDM",74018,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ebv Dna, Quant Pcr","PX-LH300970","CDM",87799,"CPT",300,"RC",{"$nulls":6},"both",null,null,171.36,171.36,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Culture Sesnitivity Enzyme","PX-LH300972","CDM",87185,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Fragile X Alleles","PX-LH300986","CDM",82144,"CPT",300,"RC",{"$nulls":6},"both",null,null,134.67,134.67,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anti-Drug Ab","PX-LH300996","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Tangential Bx Sngl Skin Lesion","PX-4903277","CDM",11102,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Incisional Biopsy Skin Ea Sep/Additional Lesion","PX-11107","CDM",11107,"CPT",982,"RC",{"$nulls":6},"both",null,null,205.98,205.98,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},28.69,68.97,null,null,"facility"]
["Injection Aa&/Strd Pudendal Nerve","PX-64430","CDM",64430,"CPT",975,"RC",{"$nulls":6},"both",null,null,282.51,282.51,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},51.48,94.7,null,null,"facility"]
["Lh Candida Species,Direct Probe","PX-LH301014","CDM",87480,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Hepatitis Be Ag","PX-LH301018","CDM",87350,"CPT",300,"RC",{"$nulls":6},"both",null,null,89,89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp","PX-66984","CDM",66984,"CPT",982,"RC",{"$nulls":6},"both",null,null,1552.08,1552.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},519.79,519.79,null,null,"facility"]
["HC Inject Aa&/Strd Nerves Nrvtg Si Joint W/Img","PX-4903350","CDM",64451,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Destruction Neurolytic Agt Genicular Nerve W/Img","PX-64624","CDM",64624,"CPT",975,"RC",{"$nulls":6},"both",null,null,1131.42,1131.42,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},139.13,378.16,null,null,"facility"]
["HC Cdsm Aim","PX-3201007","CDM","G1007","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh P190 Bcr-Abl1","PX-LH301057","CDM",81207,"CPT",300,"RC",{"$nulls":6},"both",null,null,1048,1048,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Trab","PX-LH301061","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Selenium, Blood","PX-LH301079","CDM",84255,"CPT",300,"RC",{"$nulls":6},"both",null,null,76.59,76.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Mycophenolic Acid","PX-LH301086","CDM",80180,"CPT",300,"RC",{"$nulls":6},"both",null,null,123,123,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Urine","PX-LH301093","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Urinalysis by Dipstick or Tablet Reagent W/O Micro","PX-LH81002","CDM",81002,"CPT",300,"RC",{"$nulls":6},"both",null,null,10.44,10.44,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Infectious Disease (Viral Respiratory Tract Infection), Pathogen-Specific Rna, 4 Targets","PX-LH0241U","CDM","0241U","CPT",310,"RC",{"$nulls":6},"both",null,null,427.89,427.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Iadna S Aureus Methicillin Resist Amp Probe Tq","PX-LH87641","CDM",87641,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min","PX-99234","CDM",99234,"CPT",982,"RC",{"$nulls":6},"both",null,null,274.56,274.56,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},92.27,92.27,null,null,"facility"]
["Emergency Department Visit May Not Req Phys/Qhp","PX-99281","CDM",99281,"CPT",981,"RC",{"$nulls":6},"both",null,null,31.59,31.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},10.66,10.66,null,null,"facility"]
["Lh Clot Factor VIII Multimetric","PX-LH85247","CDM",85247,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Drug Test Def 22+ Classes","PX-LHG0483","CDM","G0483","HCPCS",300,"RC",{"$nulls":6},"both",null,null,740.76,740.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Mopath Procedure Level 9","PX-LH81408","CDM",81408,"CPT",300,"RC",{"$nulls":6},"both",null,null,6000,6000,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh F2 (Prothrombin, Coagulation Factor II) Gene Analysis, 20210g>a Variant","PX-LH81240","CDM",81240,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Flow Cytometry Interpretation","PX-LH88187","CDM",88187,"CPT",300,"RC",{"$nulls":6},"both",null,null,244.14,244.14,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Xr-Skull 4+ Views","PX-3200010","CDM",70260,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Xr-Trunk Spine 2 Views","PX-3200022","CDM",72080,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Scapula","PX-3200042","CDM",73010,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Xray Hand","PX-3200057","CDM",73130,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Osseous Survey Infant","PX-3200216","CDM",77076,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3350003","CDM",96415,"CPT",335,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NM Renal Scan","PX-3410057","CDM",78700,"CPT",340,"RC",{"$nulls":6},"both",null,null,1178.91,1178.91,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NM Cardiolite per Syringe","PX-3430001","CDM","A9500","HCPCS",636,"RC",{"$nulls":6},"both",null,null,219,219,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CT-Thoracic Spine","PX-3500010","CDM",72130,"CPT",350,"RC",{"$nulls":6},"both",null,null,1127.18,1127.18,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CT-Facial Bones","PX-3510007","CDM",70487,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CT-Thorax","PX-3520010","CDM",71260,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["US Pregnancy Complete","PX-4020015","CDM",76805,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Bio Profile","PX-4020020","CDM",76819,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Vasopneumatic Device","PX-4300001","CDM",97016,"CPT",420,"RC",{"$nulls":6},"both",null,null,33.78,33.78,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Ultrasound 15 Min","PX-4300008","CDM",97035,"CPT",430,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Dysphagia Study","PX-4400003","CDM",92526,"CPT",440,"RC",{"$nulls":6},"both",null,null,247.68,247.68,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Closed Rx Mid Humerus Fx,Manipulatn","PX-4500017","CDM",24505,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Apply Finger Splint","PX-4500048","CDM",29130,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Subsequent","PX-4500062","CDM",30906,"CPT",360,"RC",{"$nulls":6},"both",null,null,698.19,698.19,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["ED Level IV","PX-4500099","CDM",99284,"CPT",450,"RC",{"$nulls":6},"both",null,null,1277.46,1277.46,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Spirometry","PX-4600000","CDM",94010,"CPT",460,"RC",{"$nulls":6},"both",null,null,446.49,446.49,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC I & D Abscess, Cmplx","PX-4900004","CDM",10061,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Remaindr Body","PX-4900035","CDM",11306,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 3.1-4cm Trunk,Arm,Le","PX-4900046","CDM",11404,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 2.1-3cm Face,Facial","PX-4900057","CDM",11443,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 2.1-3cm Trunk,Arm,Leg","PX-4900068","CDM",11603,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Remove Nail Plate Add-On","PX-4900086","CDM",11732,"CPT",450,"RC",{"$nulls":6},"both",null,null,334.41,334.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Complic","PX-4900095","CDM",11772,"CPT",761,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg 20.1-30","PX-4900124","CDM",12036,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Trunk 2.6-7.5cm","PX-4900140","CDM",13101,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Lid,Nos,Ear 2.5-7.5","PX-4900149","CDM",13152,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Inj Trigger Point,1 or 2","PX-4900319","CDM",20552,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Drain Arm Bursa","PX-4900468","CDM",23931,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Closed Rx Prox Ulna Fx,Manipulatn","PX-4900518","CDM",24675,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Close Rx Prox/Mid Fing Shft Fx,Mani","PX-4900691","CDM",26725,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Remove Foot Lesion,Tendon,Shealth,Capsule","PX-4900879","CDM",28090,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Repair Hallux Rigidus","PX-4900915","CDM",28289,"CPT",361,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Remove Gastric Port,Open","PX-4902058","CDM",43887,"CPT",761,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Proctosigmoidoscopy,Dx","PX-4902116","CDM",45300,"CPT",360,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Rpr Initial Hernia >5 Yrs Reduc","PX-4902263","CDM",49505,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Bone Marrow Aspiration","PX-4901318","CDM",38220,"CPT",450,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Remove Hydrocele","PX-4901481","CDM",55040,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Dilation & Curettage","PX-4901560","CDM",58120,"CPT",360,"RC",{"$nulls":6},"both",null,null,8936.31,8936.31,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm","PX-11302","CDM",11302,"CPT",982,"RC",{"$nulls":6},"both",null,null,398.04,398.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},56.22,133.17,null,null,"facility"]
["HC Occipital Nerve Block","PX-4901662","CDM",64405,"CPT",761,"RC",{"$nulls":6},"both",null,null,3087,3087,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 2.1-3.0 Cm","PX-11403","CDM",11403,"CPT",982,"RC",{"$nulls":6},"both",null,null,571.05,571.05,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},143.73,191.54,null,null,"facility"]
["Remove FB-Eye","PX-4901737","CDM",65220,"CPT",450,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Yag Laser","PX-4901775","CDM",66821,"CPT",360,"RC",{"$nulls":6},"both",null,null,1661.49,1661.49,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 1.1-2.0cm","PX-11442","CDM",11442,"CPT",982,"RC",{"$nulls":6},"both",null,null,559.11,559.11,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},141.59,187.43,null,null,"facility"]
["Colonoscopy","PX-4901948","CDM","G0105","HCPCS",360,"RC",{"$nulls":6},"both",null,null,2612.43,2612.43,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Excision Malignant Lesion S/N/H/F/G 1.1-2.0 Cm","PX-11622","CDM",11622,"CPT",982,"RC",{"$nulls":6},"both",null,null,731.91,731.91,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},161.43,245.25,null,null,"facility"]
["MRI-Eye/Face/Neck","PX-6100000","CDM",70540,"CPT",610,"RC",{"$nulls":6},"both",null,null,2500,2500,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Mra-Neck","PX-6100008","CDM",70549,"CPT",612,"RC",{"$nulls":6},"both",null,null,2458,2458,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["MRI Lower Extremity","PX-6100024","CDM",73718,"CPT",610,"RC",{"$nulls":6},"both",null,null,3020,3020,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["MRI-Lumbar Spine","PX-6120005","CDM",72149,"CPT",612,"RC",{"$nulls":6},"both",null,null,2458,2458,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Avulsion Nail Plate Partial/Comp Simple Ea Addl","PX-11732","CDM",11732,"CPT",982,"RC",{"$nulls":6},"both",null,null,95.43,95.43,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},15.9,31.94,null,null,"facility"]
["HC Upper GI-Inj Sclerosis Eso/Gas","PX-7500002","CDM",43243,"CPT",750,"RC",{"$nulls":6},"both",null,null,5438.97,5438.97,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500037","CDM",45385,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Excision Pilonidal Cyst/Sinus Complicated","PX-11772","CDM",11772,"CPT",982,"RC",{"$nulls":6},"both",null,null,2185.11,2185.11,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},547.1,735.7,null,null,"facility"]
["Infusion,Initial","PX-9400005","CDM",96365,"CPT",260,"RC",{"$nulls":6},"both",null,null,632.07,632.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora","PX-64633","CDM",64633,"CPT",975,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},182.89,425.53,null,null,"facility"]
["Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<","PX-12001","CDM",12001,"CPT",982,"RC",{"$nulls":6},"both",null,null,269.28,269.28,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},41.35,90.46,null,null,"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.6-7.5 Cm","PX-12042","CDM",12042,"CPT",982,"RC",{"$nulls":6},"both",null,null,896.49,896.49,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},186.66,300.28,null,null,"facility"]
["Repair Complex Scalp/Arm/Leg 1.1-2.5 Cm","PX-13120","CDM",13120,"CPT",982,"RC",{"$nulls":6},"both",null,null,1022.88,1022.88,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},219.94,342.73,null,null,"facility"]
["Repair Complx Eyelid/Nose/Ear/Lip Ea Addl 5 Cm/<","PX-13153","CDM",13153,"CPT",982,"RC",{"$nulls":6},"both",null,null,521.76,521.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},126.76,175.55,null,null,"facility"]
["CT Abdomen/Pelvis","PX-3520037","CDM",74178,"CPT",350,"RC",{"$nulls":6},"both",null,null,2427.07,2427.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Medium","PX-16025","CDM",16025,"CPT",982,"RC",{"$nulls":6},"both",null,null,448.02,448.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},104.78,150.62,null,null,"facility"]
["Injection Single/Mlt Trigger Point 3/> Muscles","PX-20553","CDM",20553,"CPT",982,"RC",{"$nulls":6},"both",null,null,173.31,173.31,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},39.51,58.17,null,null,"facility"]
["Hida Image","PX-3410076","CDM",78227,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Respite Care","PX-1200002","CDM",1200002,"LOCAL",120,"RC",{"$nulls":6},"both",null,null,1477.84,1477.84,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Creatinine, Blood","PX-LH300011","CDM",82565,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh T Protein Urine 24 Hr Ref","PX-LH300023","CDM",84156,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Tsh","PX-LH300041","CDM",84443,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Culture N/P Ref","PX-LH300052","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Bca Ref","PX-LH300063","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ua Auto W/ Micro Walhalla Clinic","PX-LH300090","CDM",81001,"CPT",300,"RC",{"$nulls":6},"both",null,null,23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh 5hiaa Ref","PX-LH300122","CDM",83497,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.7,38.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anti Cardiolpi Ref","PX-LH300130","CDM",86147,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Calc Urine Ref","PX-LH300139","CDM",82340,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Cortisol Total-Serum","PX-LH300152","CDM",82533,"CPT",300,"RC",{"$nulls":6},"both",null,null,128,128,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ferritin","PX-LH300170","CDM",82728,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Hcg, Serum Quant Ref","PX-LH300181","CDM",84702,"CPT",300,"RC",{"$nulls":6},"both",null,null,119,119,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Hla B27 Ref","PX-LH300193","CDM",86812,"CPT",300,"RC",{"$nulls":6},"both",null,null,201,201,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Igg Ref","PX-LH300199","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Lithium Ref","PX-LH300211","CDM",80178,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Porphyrines Ref","PX-LH300228","CDM",84120,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.31,44.31,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Prolactin Ref","PX-LH300333","CDM",84146,"CPT",300,"RC",{"$nulls":6},"both",null,null,152,152,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Smear Special Grp II Ref","PX-LH300344","CDM",88313,"CPT",300,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Vancomycin Ref","PX-LH300362","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Alpha 1 Antitry Total","PX-LH300373","CDM",82103,"CPT",300,"RC",{"$nulls":6},"both",null,null,104,104,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Phenobarbital Ref","PX-LH300380","CDM",80184,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.9,45.9,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Crp High Sensitiv Ref","PX-LH300389","CDM",86141,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Oxalate, Urine","PX-LH300400","CDM",83945,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Iga Ref","PX-LH300417","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Heavy Metal Urin Arsenic","PX-LH300428","CDM",82175,"CPT",300,"RC",{"$nulls":6},"both",null,null,149,149,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Rapid Strep WC","PX-LH300439","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Culture Fungal Skn,Hair,Nail","PX-LH300444","CDM",87101,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.13,23.13,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Factor II Ref","PX-LH300457","CDM",85210,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.94,38.94,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anafranil, Serum","PX-LH300475","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Protein C Activity Ref","PX-LH300487","CDM",85303,"CPT",300,"RC",{"$nulls":6},"both",null,null,108,108,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ace Ref","PX-LH300499","CDM",82164,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh H-6","PX-LH300506","CDM",85007,"CPT",300,"RC",{"$nulls":6},"both",null,null,28,28,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Chloride Stool Ref","PX-LH300529","CDM",82438,"CPT",300,"RC",{"$nulls":6},"both",null,null,15,15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ebv,Capsid HB, Igm Ref.","PX-LH300533","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Cyclic Amp(Urine) Ref","PX-LH300545","CDM",82030,"CPT",300,"RC",{"$nulls":6},"both",null,null,77.4,77.4,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Influenza a - Walhalla Clinic","PX-LH300556","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Hcv Genotyping Ref","PX-LH300574","CDM",87902,"CPT",300,"RC",{"$nulls":6},"both",null,null,772.35,772.35,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Amindeuelinic & Porph. Ref Enzyme Activity Nonradioactive Substrate","PX-LH300587","CDM",82657,"CPT",300,"RC",{"$nulls":6},"both",null,null,66.51,66.51,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Scabies Ref","PX-LH300599","CDM",87220,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Copper Serum, Ref","PX-LH300605","CDM",82525,"CPT",300,"RC",{"$nulls":6},"both",null,null,100,100,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Cyclic Citrillinated Peptide Ref","PX-LH300616","CDM",86200,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Manganese Ref","PX-LH300634","CDM",83785,"CPT",300,"RC",{"$nulls":6},"both",null,null,79.95,79.95,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Hepatitis D Igm Ref","PX-LH300645","CDM",86692,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.48,51.48,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Cortisol Total Salivary Ref","PX-LH300656","CDM",82533,"CPT",300,"RC",{"$nulls":6},"both",null,null,128,128,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Alpha 1-Antitryspin Pheno Serum","PX-LH300661","CDM",82104,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.38,43.38,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Pneumoccal Ag Ua Ref","PX-LH300672","CDM",86403,"CPT",300,"RC",{"$nulls":6},"both",null,null,34.62,34.62,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ldh Fluid Ref","PX-LH300688","CDM","LH300688","LOCAL",300,"RC",{"$nulls":6},"both",null,null,91,91,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Bcan X 3 Ref","PX-LH300701","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Igg Latex Ref","PX-LH300712","CDM",86001,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Pro-12(Trig/Ldl)","PX-LH300729","CDM",84478,"CPT",300,"RC",{"$nulls":6},"both",null,null,46,46,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Beta 2-Gly Pro Anti Ref","PX-LH300742","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh TB Gold Ref","PX-LH300755","CDM",86480,"CPT",300,"RC",{"$nulls":6},"both",null,null,504,504,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Fta-Abs Ref","PX-LH300760","CDM",86780,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Tissue Level 4 X 5 Ref","PX-LH300771","CDM",88305,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Vitamin B3 Niacin","PX-LH300788","CDM",84591,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.18,51.18,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Immunhistochemistry Init Sngl Ab Stn","PX-LH700006","CDM",88342,"CPT",300,"RC",{"$nulls":6},"both",null,null,514.08,514.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Clavicle Brace","PX-LH200550","CDM","LH200550","LOCAL",270,"RC",{"$nulls":6},"both",null,null,28.56,28.56,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Pacemaker Electrode, Pediatric","PX-LH200942","CDM","LH200942","LOCAL",270,"RC",{"$nulls":6},"both",null,null,116.25,116.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Ankle Brace-As0","PX-LH201776","CDM","LH201776","LOCAL",270,"RC",{"$nulls":6},"both",null,null,55.95,55.95,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Strapping Elbow/Wrist","PX-LH461032","CDM",29260,"HCPCS",270,"RC",{"$nulls":6},"both",null,null,48.9,48.9,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Doppler Upper Ext,Arteries","PX-9210028","CDM",93890,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anesthesia Vasectomy Unilat/Bilat","PX-LH4400921","CDM",921,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anesthesia Ear","PX-LH4400120","CDM",120,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Emergency Fee","PX-LH99050","CDM","LH99050","LOCAL",402,"RC",{"$nulls":6},"both",null,null,179,179,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh RBC Leuko Reduc Unit 3","PX-LH300112","CDM","P9016","HCPCS",390,"RC",{"$nulls":6},"both",null,null,542.46,542.46,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Treatment Room,Low Level","PX-LH099212","CDM",99212,"CPT",761,"RC",{"$nulls":6},"both",null,null,377.85,377.85,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC C-Pap","PX-4100019","CDM",94660,"CPT",410,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Trauma Activation Beyond Level IV Assoc W/ Crit Care","PX-LHG0390BEY","CDM","G0390","HCPCS",689,"RC",{"$nulls":6},"both",null,null,3969,3969,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["GLYCOPYRROLATE 1 MG PO TABS","RX-10130","CDM",6370005,"HCPCS",250,"RC","00904-6709-61","NDC",{"$nulls":4},"both",1,"UN",6,6,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["LEVONORGESTREL 1.5 MG PO TABS","RX-103335","CDM",6370005,"HCPCS",250,"RC","00536-1142-63","NDC",{"$nulls":4},"both",1,"UN",24.75,24.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["LEUPROLIDE ACETATE 7.5 MG IM KIT","RX-10392","CDM","J9217","HCPCS",636,"RC","00074-3642-03","NDC",{"$nulls":4},"both",7.5,"ME",2805.5,2805.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["ACETAMINOPHEN 650 MG REC SUPP","RX-105","CDM",6370005,"HCPCS",250,"RC","45802-0730-00","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["ONDANSETRON HCL 4 MG PO TABS","RX-10778","CDM","Q0162","HCPCS",250,"RC","00904-6551-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["PHYTONADIONE 10 MG/ML INJ SOLN","RX-11023","CDM",2500006,"HCPCS",250,"RC","43598-0405-16","NDC",{"$nulls":4},"both",1,"ML",89.25,89.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","RX-111126","CDM","J1956","HCPCS",636,"RC","00143-9722-01","NDC",{"$nulls":4},"both",50,"ML",58.75,58.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["BENZOCAINE-MENTHOL 15-10 MG MT LOZG","RX-113950","CDM",6370005,"HCPCS",250,"RC","78112-0017-46","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","RX-11567","CDM","J3490","HCPCS",250,"RC","00574-4031-25","NDC",{"$nulls":4},"both",2.5,"ML",77.75,77.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["PHYTONADIONE 1 MG/0.5ML INJ SOLN","RX-120964","CDM","J3430","HCPCS",636,"RC","76329-1240-01","NDC",{"$nulls":4},"both",0.5,"ML",48.25,48.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["BUPIVACAINE HCL 0.5 % INJ SOLN","RX-1223","CDM","J0665","HCPCS",636,"RC","55150-0250-50","NDC",{"$nulls":4},"both",50,"ML",23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["TBO-FILGRASTIM 300 MCG/0.5ML SC SOSY","RX-126459","CDM","J1447","HCPCS",636,"RC","63459-0910-15","NDC",{"$nulls":4},"both",0.5,"ML",513.25,513.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["EPINEPHRINE 0.3 MG/0.3ML INJ SOAJ","RX-127484","CDM","J0171","HCPCS",636,"RC","00115-1694-49","NDC",{"$nulls":4},"both",0.3,"ML",431.75,431.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["PEGFILGRASTIM 6 MG/0.6ML SC SOSY","RX-133089","CDM","J2506","HCPCS",636,"RC","55513-0190-01","NDC",{"$nulls":4},"both",0.6,"ML",7971.25,7971.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["BUDESONIDE 3 MG PO CPEP","RX-134897","CDM",6370005,"HCPCS",250,"RC","00574-9855-10","NDC",{"$nulls":4},"both",1,"UN",5,5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["FENTANYL CITRATE (PF) 100 MCG/2ML INJ SOLN","RX-134932","CDM","J3010","HCPCS",636,"RC","00641-6027-25","NDC",{"$nulls":4},"both",2,"ML",23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["INFLIXIMAB-DYYB 100 MG IV SOLR","RX-137250","CDM","Q5103","HCPCS",636,"RC","00069-0809-01","NDC",{"$nulls":4},"both",100,"ME",804.25,804.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CARBOXYMETHYLCELLULOSE SOD PF 1 % OP GEL","RX-140766","CDM",6370005,"HCPCS",250,"RC","00023-4554-30","NDC",{"$nulls":4},"both",1,"UN",5.25,5.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["PALIPERIDONE PALMITATE ER 117 MG/0.75ML IM SUSY","RX-144873","CDM","J2426","HCPCS",636,"RC","50458-0562-01","NDC",{"$nulls":4},"both",0.75,"ML",2481.25,2481.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["MIDAZOLAM HCL (PF) 10 MG/2ML INJ SOLN","RX-146236","CDM","J2250","HCPCS",636,"RC","00409-2308-02","NDC",{"$nulls":4},"both",2,"ML",23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["SEMAGLUTIDE 7 MG PO TABS","RX-146407","CDM",6370005,"HCPCS",250,"RC","00169-4307-30","NDC",{"$nulls":4},"both",1,"UN",127,127,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["FLUTICASONE-SALMETEROL 100-50 MCG/ACT IN AEPB","RX-153700","CDM","J3535","HCPCS",250,"RC","66993-0584-97","NDC",{"$nulls":4},"both",60,"UN",411.75,411.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["FLUTICASONE FUROATE-VILANTEROL 100-25 MCG/ACT IN AEPB","RX-155090","CDM","J3535","HCPCS",250,"RC","00173-0859-14","NDC",{"$nulls":4},"both",28,"UN",248.25,248.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["METHYLPREDNISOLONE NA SUC (PF) 40 MG INJ SOLR","RX-156483","CDM","J2919","HCPCS",636,"RC","00009-0039-05","NDC",{"$nulls":4},"both",1,"ML",38.5,38.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["PNEUMOCOCCAL VAC POLYVALENT 25 MCG/0.5ML INJ SOSY","RX-160845","CDM",90732,"HCPCS",636,"RC","00006-4837-03","NDC",{"$nulls":4},"both",0.5,"ML",203.25,203.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["IODIXANOL 270 MG/ML IV SOLN","RX-17594","CDM","Q9966","HCPCS",255,"RC","00407-2222-17","NDC",{"$nulls":4},"both",100,"ML",207.5,207.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["LEVOFLOXACIN 500 MG PO TABS","RX-18919","CDM",6370005,"HCPCS",250,"RC","00904-6352-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CYPROHEPTADINE HCL 4 MG PO TABS","RX-2033","CDM",6370005,"HCPCS",250,"RC","00115-1757-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["AZITHROMYCIN 500 MG IV SOLR","RX-21063","CDM","J0456","HCPCS",636,"RC","70095-0025-01","NDC",{"$nulls":4},"both",500,"ME",23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","RX-22982","CDM",6370005,"HCPCS",250,"RC","24208-0486-10","NDC",{"$nulls":4},"both",10,"ML",5.25,5.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["DIAZEPAM 5 MG PO TABS","RX-2405","CDM",6370005,"HCPCS",250,"RC","51079-0285-20","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["FEXOFENADINE HCL 180 MG PO TABS","RX-25425","CDM",6370005,"HCPCS",250,"RC","41167-4120-03","NDC",{"$nulls":4},"both",1,"UN",5,5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["ACETAMINOPHEN 160 MG/5ML PO LIQD","RX-26969","CDM","J3490","HCPCS",250,"RC","58657-0525-04","NDC",{"$nulls":4},"both",120,"ML",22.75,22.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["ONDANSETRON 4 MG PO TBDP","RX-27697","CDM","Q0162","HCPCS",250,"RC","68462-0157-40","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["VENLAFAXINE HCL ER 37.5 MG PO CP24","RX-27857","CDM",6370005,"HCPCS",250,"RC","68084-0698-01","NDC",{"$nulls":4},"both",1,"UN",4.5,4.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN","RX-29302","CDM","J7510","HCPCS",636,"RC","00121-0759-08","NDC",{"$nulls":4},"both",237,"ML",208.75,208.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["METOPROLOL SUCCINATE ER 50 MG PO TB24","RX-30070","CDM",6370005,"HCPCS",250,"RC","00904-6323-61","NDC",{"$nulls":4},"both",1,"UN",4,4,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["FUROSEMIDE 20 MG PO TABS","RX-3294","CDM",6370005,"HCPCS",250,"RC","00904-7177-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NICOTINE POLACRILEX 2 MG MT LOZG","RX-34769","CDM",6370005,"HCPCS",250,"RC","00113-0344-03","NDC",{"$nulls":4},"both",1,"UN",4,4,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HYDROMORPHONE HCL 1 MG/ML INJ SOLN","RX-3757","CDM","J1171","HCPCS",636,"RC","00409-1283-31","NDC",{"$nulls":4},"both",1,"ML",23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["LACTULOSE 10 GM/15ML PO SOLN","RX-38245","CDM","J8499","HCPCS",250,"RC","00121-4577-15","NDC",{"$nulls":4},"both",15,"ML",6.5,6.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["LACTULOSE ENCEPHALOPATHY 10 GM/15ML PO SOLN","RX-38969","CDM",6370005,"HCPCS",250,"RC","60432-0038-16","NDC",{"$nulls":4},"both",473,"ML",45.75,45.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["ISOSORBIDE DINITRATE 30 MG PO TABS","RX-4066","CDM",6370005,"HCPCS",250,"RC","49884-0009-01","NDC",{"$nulls":4},"both",1,"UN",5.75,5.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["PREGABALIN 50 MG PO CAPS","RX-42163","CDM",6370005,"HCPCS",250,"RC","64980-0411-09","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["LISINOPRIL 20 MG PO TABS","RX-4526","CDM",6370005,"HCPCS",250,"RC","00904-6799-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["MAGNESIUM SULFATE 50 % INJ SOLN","RX-4720","CDM","J3475","HCPCS",636,"RC","63323-0064-01","NDC",{"$nulls":4},"both",2,"ML",23,23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NITROFURANTOIN MACROCRYSTAL 100 MG PO CAPS","RX-5593","CDM",6370005,"HCPCS",250,"RC","70756-0412-11","NDC",{"$nulls":4},"both",1,"UN",5.5,5.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NYSTATIN 100000 UNIT/ML MT SUSP","RX-5751","CDM",6370005,"HCPCS",250,"RC","00904-7276-41","NDC",{"$nulls":4},"both",5,"ML",5.75,5.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["TENECTEPLASE 50MG IV FOR STROKE","RX-600949","CDM","J3101","HCPCS",636,"RC","50242-0120-47","NDC",{"$nulls":4},"both",10,"ML",15023.25,15023.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["PROMETHAZINE HCL 25 MG PO TABS","RX-6622","CDM","Q0169","HCPCS",250,"RC","10702-0003-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["POTASSIUM & SODIUM PHOSPHATES 280-160-250 MG PO PACK","RX-70284","CDM",6370005,"HCPCS",250,"RC","60258-0006-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["SODIUM CHLORIDE 0.45 % IV SOLN","RX-7318","CDM","J3490","HCPCS",636,"RC","00338-0043-04","NDC",{"$nulls":4},"both",1000,"ML",55,55,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["DOBUTAMINE HCL 250 MG/20ML IV SOLN","RX-77318","CDM","J1250","HCPCS",636,"RC","00409-2344-62","NDC",{"$nulls":4},"both",20,"ML",41.25,41.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["TRIAMTERENE-HCTZ 37.5-25 MG PO TABS","RX-8132","CDM",6370005,"HCPCS",250,"RC","68084-0750-95","NDC",{"$nulls":4},"both",1,"UN",5.5,5.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","RX-856","CDM",2500006,"HCPCS",250,"RC","24208-0555-55","NDC",{"$nulls":4},"both",3.5,"GR",30.25,30.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["WARFARIN SODIUM 2.5 MG PO TABS","RX-8750","CDM",6370005,"HCPCS",250,"RC","00832-1213-89","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["ACYCLOVIR 5 % EX OINT","RX-8968","CDM",6370005,"HCPCS",250,"RC","65162-0835-94","NDC",{"$nulls":4},"both",15,"GR",79,79,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["BENAZEPRIL HCL 5 MG PO TABS","RX-9223","CDM",6370005,"HCPCS",250,"RC","50268-0109-15","NDC",{"$nulls":4},"both",1,"UN",4,4,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CALCITONIN (SALMON) 200 UNIT/ML INJ SOLN","RX-9347","CDM","J0630","HCPCS",636,"RC","24201-0400-02","NDC",{"$nulls":4},"both",2,"ML",4436.5,4436.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CEFPODOXIME PROXETIL 100 MG PO TABS","RX-9468","CDM",6370005,"HCPCS",250,"RC","00781-5438-20","NDC",{"$nulls":4},"both",1,"UN",14.75,14.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CEPHALEXIN 500 MG PO CAPS","RX-9500","CDM",6370005,"HCPCS",250,"RC","50090-2749-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["CLONAZEPAM 0.5 MG PO TABS","RX-9637","CDM",6370005,"HCPCS",250,"RC","50090-2088-00","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Surgical Path-Level VI","PX-401536087","CDM",88309,"CPT",312,"RC",{"$nulls":6},"both",null,null,2457.87,2457.87,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Closed Tx Patellar Dislocation W/O Anesthesia","PX-27560","CDM",27560,"CPT",982,"RC",{"$nulls":6},"both",null,null,1096.59,1096.59,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},335.43,369.16,null,null,"facility"]
["Thyroid Imaging","PX-3410086","CDM",78014,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Fecal Fat,Total Quant","PX-LH300796","CDM",82710,"CPT",300,"RC",{"$nulls":6},"both",null,null,129,129,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Capillary Draw","PX-LH300839","CDM",36416,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.82,35.82,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Ag Class I (E,K)","PX-LH300810","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Colect W/Coloproctostomy","PX-4902528","CDM",44145,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Removal Impacted Cerumen Irrigation/Lvg Unilat","PX-69209","CDM",69209,"CPT",982,"RC",{"$nulls":6},"both",null,null,46.53,46.53,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},13.23,15.56,null,null,"facility"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",975,"RC",{"$nulls":6},"both",null,null,654,654,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},220.52,220.52,null,null,"facility"]
["HC Glucose Monitor Report Reading","PX-5100060","CDM",95251,"CPT",942,"RC",{"$nulls":6},"both",null,null,98.76,98.76,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Anti-Mullerian Hormone","PX-LH300877","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["MRI Brain W/O & W/Dye","PX-6110022","CDM",70559,"CPT",611,"RC",{"$nulls":6},"both",null,null,3305.81,3305.81,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Olanzapine (Zypresa)","PX-LH300896","CDM",80342,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh C.Diff-Ia","PX-LH300967","CDM",87449,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Culture Fungal (Excl Bld/Skin,Hair,Nail)","PX-LH301000","CDM",87102,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.23,25.23,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Occult Blood Fecal Globin Immuno","PX-LH301009","CDM",82274,"CPT",300,"RC",{"$nulls":6},"both",null,null,47.76,47.76,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Rmvl FB Xtrnl Eye Corneal W/O Slit Lamp","PX-65220","CDM",65220,"CPT",982,"RC",{"$nulls":6},"both",null,null,173.31,173.31,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},38.85,58.17,null,null,"facility"]
["Lh Mlh1 Gene Full Seq","PX-LH301043","CDM",81292,"CPT",300,"RC",{"$nulls":6},"both",null,null,2026.2,2026.2,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Cdsm Ndsc","PX-3201004","CDM","G1004","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Needle Insert W/O Inj 3+ Musc","PX-4903368","CDM",20561,"CPT",420,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Pregablin,Urine,Quant","PX-LH301075","CDM",80366,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Im Adm Prq ID Subq/Im Njxs 1 Vaccine","PX-90471","CDM",90471,"CPT",982,"RC",{"$nulls":6},"both",null,null,60.3,60.3,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},20.14,20.14,null,null,"facility"]
["Lh Cryptosporidium Ag Ia","PX-LH87328","CDM",87328,"CPT",306,"RC",{"$nulls":6},"both",null,null,95,95,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Hospital IP/Obs Discharge Day Mgmt > 30 Min","PX-99239","CDM",99239,"CPT",982,"RC",{"$nulls":6},"both",null,null,324.87,324.87,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},108.96,108.96,null,null,"facility"]
["Lh Interleukin 6","PX-LH83529","CDM",83529,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Resp Syncytial Virus Ag Ia","PX-LH87420","CDM",87420,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.73,41.73,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Apolipoprotein B","PX-LH82172","CDM",82172,"CPT",300,"RC",{"$nulls":6},"both",null,null,63.27,63.27,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Xray Pelvis","PX-3200028","CDM",72170,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Xray Knees-Standing","PX-3200070","CDM",73565,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Bone Survey Complete","PX-3200215","CDM",77075,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CT Upper Extremity","PX-3500017","CDM",73201,"CPT",350,"RC",{"$nulls":6},"both",null,null,2427.07,2427.07,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520009","CDM",74170,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Echo Exam of Head","PX-4020000","CDM",76506,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.25,319.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Gait Training","PX-4200009","CDM",97116,"CPT",420,"RC",{"$nulls":6},"both",null,null,85.83,85.83,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Closed Rx Mid Humerus Fracture","PX-4500016","CDM",24500,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Apply Short Leg Cast,Walker","PX-4500053","CDM",29425,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Debride Infected Skin","PX-4560000","CDM",11000,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC I & D Abscess, Smpl","PX-4900003","CDM",10060,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Face,Facial","PX-4900039","CDM",11311,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Trunk,Arm,Leg","PX-4900066","CDM",11601,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 7.6-12.5","PX-4900116","CDM",12015,"CPT",360,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Rep,Face,Genital,Hand,Ft+5cm/<","PX-4900146","CDM",13133,"CPT",360,"RC",{"$nulls":6},"both",null,null,973.17,973.17,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Destroy Premlg Lesions 15+","PX-4900241","CDM",17004,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Closed Rx Shldr Disloc,Anesthesia","PX-4900462","CDM",23655,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Part Removal of Foot Bone","PX-4900914","CDM",28288,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Correct Bunion,Metatarsal Osteotomy","PX-4900919","CDM",28296,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Rpr Initial Hernia >5 Yrs Reduc","PX-4902263","CDM",49505,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Removal of Testis Smpl","PX-4901466","CDM",54520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9964.74,9964.74,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Pudendal Nerve Block","PX-4901670","CDM",64430,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Remove FB From Eye Embed Conjunc","PX-4901736","CDM",65210,"CPT",450,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 2.1-3.0cm","PX-11423","CDM",11423,"CPT",982,"RC",{"$nulls":6},"both",null,null,592.65,592.65,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},150.94,198.74,null,null,"facility"]
["HC Incise Eardrum,Aspir,Gen Anesth","PX-4901890","CDM",69421,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Mileage","PX-5420001","CDM","A0425","HCPCS",540,"RC",{"$nulls":6},"both",null,null,27.06,27.06,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Excision Malignant Lesion F/E/E/N/L >4.0 Cm","PX-11646","CDM",11646,"CPT",982,"RC",{"$nulls":6},"both",null,null,1430.1,1430.1,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},364.5,481.07,null,null,"facility"]
["HC Upper GI Endoscopy,Biopsy","PX-7500001","CDM",43239,"CPT",360,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500036","CDM",45384,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Venous Imaging","PX-9210020","CDM",93970,"CPT",921,"RC",{"$nulls":6},"both",null,null,725.16,725.16,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Cardiac Rehab/Phase I Non-Monitored","PX-9430000","CDM",93797,"CPT",943,"RC",{"$nulls":6},"both",null,null,377.7,377.7,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.5cm/<","PX-12041","CDM",12041,"CPT",982,"RC",{"$nulls":6},"both",null,null,763.2,763.2,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},138.33,255.55,null,null,"facility"]
["HC Tomo Screening Bilat Add-On","PX-4030005","CDM",77063,"CPT",403,"RC",{"$nulls":6},"both",null,null,129,129,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Injection Single Tendon Origin/Insertion","PX-20551","CDM",20551,"CPT",982,"RC",{"$nulls":6},"both",null,null,164.49,164.49,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},36.23,55.22,null,null,"facility"]
["Lh Amylase","PX-LH300017","CDM",82150,"CPT",300,"RC",{"$nulls":6},"both",null,null,51,51,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh T3 Uptake Ref","PX-LH300040","CDM",84479,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.41,19.41,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Culture Fluid Ref","PX-LH300051","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Mono","PX-LH300077","CDM",86308,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Aldosterone-Uri","PX-LH300126","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Extrac Nuc Ab","PX-LH300164","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Hbsag Ref","PX-LH300187","CDM",87340,"CPT",300,"RC",{"$nulls":6},"both",null,null,31.75,31.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Ibc","PX-LH300198","CDM",83550,"CPT",300,"RC",{"$nulls":6},"both",null,null,72,72,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Neurontin (Gaba)","PX-LH300221","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Quinidin Ref","PX-LH300337","CDM",80194,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.8,43.8,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Mixing Study Ptt","PX-LH300381","CDM",85730,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Chromosome Analysis CT 15-20 Cells","PX-LH300393","CDM",88262,"CPT",300,"RC",{"$nulls":6},"both",null,null,376.47,376.47,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Neut Cytoplasmi","PX-LH300415","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Beta 2 Microglobulin","PX-LH300450","CDM",82232,"CPT",300,"RC",{"$nulls":6},"both",null,null,122,122,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Somatomedin Igf","PX-LH300474","CDM",84305,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Factor V Mut","PX-LH300486","CDM",81241,"CPT",300,"RC",{"$nulls":6},"both",null,null,170,170,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Pro-3 Cmp","PX-LH300510","CDM",80053,"CPT",300,"RC",{"$nulls":6},"both",null,null,82,82,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Ebv,Capsid HB, Igm Ref.","PX-LH300533","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Anti Ssa/Ro Ref","PX-LH300568","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Antiglomerculu Basement Membrane Re Quantitative Nos","PX-LH300593","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Ticihomonas Culture Vaginal Ref","PX-LH300615","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Ld Iso Enzyme Ref","PX-LH300626","CDM",83625,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.37,38.37,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cmv Quant Ref","PX-LH300649","CDM",87497,"CPT",300,"RC",{"$nulls":6},"both",null,null,343,343,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Ana Profile Ref","PX-LH300691","CDM",86038,"CPT",300,"RC",{"$nulls":6},"both",null,null,96,96,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Myeloperoxidase Ab Ref","PX-LH300705","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Pro-10(Chol/Ldl)","PX-LH300727","CDM",82465,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Tissue Level 3 X 4 Ref","PX-LH300765","CDM",88304,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Coxsackie B Panel Ref","PX-LH300787","CDM",86658,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.09,39.09,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Nucleic Acid, High Resolute Amp","PX-LH700005","CDM",87801,"CPT",300,"RC",{"$nulls":6},"both",null,null,210.6,210.6,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Knee Brace(Immobilizer)","PX-LH201360","CDM","LH201360","LOCAL",270,"RC",{"$nulls":6},"both",null,null,67.62,67.62,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Hourly Observation W/Monitor","PX-7621000","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,1118,1118,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Anesthesia Inguinal Hernia","PX-LH4400830","CDM",830,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Diabetic Teaching-Pre","PX-LH98963","CDM","LH98963","LOCAL",942,"RC",{"$nulls":6},"both",null,null,300,300,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Airway Inhalation Trmt Subsq","PX-4100018","CDM",94640,"CPT",410,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Trauma Activation Level IV Assoc W/ Critical","PX-LHG0390L4","CDM","G0390","HCPCS",684,"RC",{"$nulls":6},"both",null,null,9000,9000,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["IBUPROFEN 100 MG/5ML PO SUSP","RX-10246","CDM","J3490","HCPCS",250,"RC","00904-5309-20","NDC",{"$nulls":4},"both",120,"ML",18.5,18.5,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["ENOXAPARIN SODIUM 100 MG/ML SC SOLN","RX-108205","CDM","J1650","HCPCS",636,"RC","00955-1010-01","NDC",{"$nulls":4},"both",1,"ML",48.75,48.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["MEDIHONEY WOUND/BURN DRESSING EX GEL","RX-110566","CDM",2500006,"HCPCS",250,"RC","09958-0034-60","NDC",{"$nulls":4},"both",15,"ML",27.25,27.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["SIMVASTATIN 10 MG PO TABS","RX-11364","CDM",6370005,"HCPCS",250,"RC","63739-0571-10","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["TIMOLOL MALEATE 0.5 % OP SOLN","RX-11562","CDM",6370005,"HCPCS",250,"RC","61314-0227-05","NDC",{"$nulls":4},"both",5,"ML",26.75,26.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["EMPAGLIFLOZIN 10 MG PO TABS","RX-129061","CDM",6370005,"HCPCS",250,"RC","00597-0152-30","NDC",{"$nulls":4},"both",1,"UN",62.75,62.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["VERAPAMIL HCL ER 120 MG PO TBCR","RX-13184","CDM",6370005,"HCPCS",250,"RC","68462-0292-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["FLUCONAZOLE 150 MG PO TABS","RX-13577","CDM",6370005,"HCPCS",250,"RC","57237-0005-11","NDC",{"$nulls":4},"both",1,"UN",6.75,6.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["BACLOFEN 5 MG PO TABS","RX-142513","CDM",6370005,"HCPCS",250,"RC","71930-0066-12","NDC",{"$nulls":4},"both",1,"UN",5.25,5.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","RX-148387","CDM",6370005,"HCPCS",250,"RC","68094-0129-62","NDC",{"$nulls":4},"both",15,"ML",14.5,14.5,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["RISANKIZUMAB-RZAA 600 MG/10ML IV SOLN","RX-154319","CDM","J2327","HCPCS",636,"RC","00074-5015-01","NDC",{"$nulls":4},"both",600,"ME",14492,14492,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["FLEET SALINE ENEMA 7-19 GM/197ML REC ENEM","RX-160285","CDM",2500006,"HCPCS",250,"RC","00132-0201-40","NDC",{"$nulls":4},"both",1,"UN",11,11,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CLONIDINE HCL 0.1 MG PO TABS","RX-1755","CDM",6370005,"HCPCS",250,"RC","60687-0113-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["ZINC OXIDE 40 % EX OINT","RX-19672","CDM",6370005,"HCPCS",250,"RC","63868-0593-57","NDC",{"$nulls":4},"both",28,"GR",10.75,10.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["ISOSORBIDE MONONITRATE ER 60 MG PO TB24","RX-24268","CDM",6370005,"HCPCS",250,"RC","00904-6450-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["PANTOPRAZOLE SODIUM 20 MG PO TBEC","RX-26224","CDM",6370005,"HCPCS",250,"RC","00008-0843-81","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["SODIUM CHLORIDE 0.9 % IV SOLN","RX-27838","CDM","J7040","HCPCS",258,"RC","00338-0049-03","NDC",{"$nulls":4},"both",500,"ML",57.75,57.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["FENOFIBRATE 160 MG PO TABS","RX-28252","CDM",6370005,"HCPCS",250,"RC","00115-5522-10","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["VALSARTAN 160 MG PO TABS","RX-31210","CDM",6370005,"HCPCS",250,"RC","60687-0634-11","NDC",{"$nulls":4},"both",1,"UN",8.75,8.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["PROPRANOLOL HCL ER 80 MG PO CP24","RX-38225","CDM",6370005,"HCPCS",250,"RC","00228-2779-11","NDC",{"$nulls":4},"both",1,"UN",13,13,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["DULOXETINE HCL 60 MG PO CPEP","RX-39277","CDM",6370005,"HCPCS",250,"RC","00904-7045-61","NDC",{"$nulls":4},"both",1,"UN",6.5,6.5,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["LEVOTHYROXINE SODIUM 50 MCG PO TABS","RX-4421","CDM",6370005,"HCPCS",250,"RC","00527-3281-46","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["NITROFURANTOIN MACROCRYSTAL 100 MG PO CAPS","RX-5593","CDM",6370005,"HCPCS",250,"RC","70756-0412-11","NDC",{"$nulls":4},"both",1,"UN",5.5,5.5,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["PHENAZOPYRIDINE HCL 95 MG PO TABS","RX-6195","CDM",2500006,"HCPCS",250,"RC","87651-0301-52","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["BRIMONIDINE TARTRATE 0.1 % OP SOLN","RX-70262","CDM",2500006,"HCPCS",250,"RC","00023-9321-05","NDC",{"$nulls":4},"both",5,"ML",402.75,402.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["SODIUM BICARBONATE 650 MG PO TABS","RX-7313","CDM",6370005,"HCPCS",250,"RC","00904-7261-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CLINDAMYCIN PHOSPHATE 600 MG/4ML INJ SOLN","RX-82301","CDM","J0736","HCPCS",636,"RC","00009-0775-26","NDC",{"$nulls":4},"both",4,"ML",23,23,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["ACYCLOVIR 5 % EX CREA","RX-8967","CDM",6370005,"HCPCS",250,"RC","00093-3630-20","NDC",{"$nulls":4},"both",5,"GR",1610.25,1610.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["VITAMIN D3 25 MCG (1000 UT) PO CAPS","RX-92866","CDM",6370005,"HCPCS",250,"RC","54458-0323-44","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CEPHALEXIN 250 MG PO CAPS","RX-9499","CDM",6370005,"HCPCS",250,"RC","60687-0152-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CIPROFLOXACIN HCL 0.3 % OP SOLN","RX-9610","CDM","J3490","HCPCS",250,"RC","61314-0656-25","NDC",{"$nulls":4},"both",2.5,"ML",20.25,20.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Special Stain-Group I","PX-401536070","CDM",88312,"CPT",312,"RC",{"$nulls":6},"both",null,null,160.29,160.29,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Shbg","PX-LH300791","CDM",84270,"CPT",300,"RC",{"$nulls":6},"both",null,null,171,171,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Application Finger Splint Static","PX-29130","CDM",29130,"CPT",982,"RC",{"$nulls":6},"both",null,null,120.27,120.27,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},27.06,40.49,null,null,"facility"]
["Myocardial Spect Multiple Studies","PX-78452","CDM",78452,"CPT",972,"RC",{"$nulls":6},"both",null,null,4058.79,4058.79,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},72.07,72.07,null,null,"facility"]
["HC Inj Paravert F Jnt C/T 1 Lev","PX-4903053","CDM",64490,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["C1 Inhibitor,Functional","PX-LH300846","CDM",86161,"CPT",300,"RC",{"$nulls":6},"both",null,null,36,36,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Exc Lesion Tongue W/Clsr Anterior Two-Thirds","PX-41112","CDM",41112,"CPT",982,"RC",{"$nulls":6},"both",null,null,981.09,981.09,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},234.32,328.62,null,null,"facility"]
["Lh Tpmt Activity Mass Spectometry","PX-LH300822","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Colectomy Partial W/Anastomosis","PX-44140","CDM",44140,"CPT",975,"RC",{"$nulls":6},"both",null,null,3622.2,3622.2,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},1231.05,1231.05,null,null,"facility"]
["Lh Flu Vaccine Iiv4 Splt 0.5ml Im","PX-LH90688","CDM",90688,"CPT",636,"RC",{"$nulls":6},"both",null,null,62.61,62.61,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["MRI Brain W/O & W/Dye","PX-6110022","CDM",70559,"CPT",611,"RC",{"$nulls":6},"both",null,null,3305.81,3305.81,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Olanzapine (Zypresa)","PX-LH300896","CDM",80342,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Xray Chest 2 Views","PX-3240021","CDM",71046,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Fish Bcr/Abl IP Situ 100-200 Cells Ref","PX-LH300981","CDM",88275,"CPT",300,"RC",{"$nulls":6},"both",null,null,153.57,153.57,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Fungal Smear Fluores/Af Stain","PX-LH301001","CDM",87206,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.17,16.17,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl","PX-64421","CDM",64421,"CPT",975,"RC",{"$nulls":6},"both",null,null,95.19,95.19,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},23.44,31.95,null,null,"facility"]
["Removal FB Eye Conjunctival Superficial","PX-65205","CDM",65205,"CPT",982,"RC",{"$nulls":6},"both",null,null,81.99,81.99,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},27.36,27.69,null,null,"facility"]
["Injection Aa&/Strd Genicular Nrv Branches W/Img","PX-64454","CDM",64454,"CPT",975,"RC",{"$nulls":6},"both",null,null,645.72,645.72,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},78.01,215.86,null,null,"facility"]
["US Guidance Needle Placement Img S&I","PX-76942","CDM",76942,"CPT",972,"RC",{"$nulls":6},"both",null,null,2360.13,2360.13,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},27.67,56.34,null,null,"facility"]
["Lh Pregablin,Urine,Quant,Medicare","PX-LH301076","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,430.29,430.29,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Ext Ecg >7d<15d Recording","PX-7310017","CDM",93246,"CPT",360,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only","PX-93017","CDM",93017,"CPT",985,"RC",{"$nulls":6},"both",null,null,109.8,109.8,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},36.68,36.68,null,null,"facility"]
["Lh Therapeutic Drug Assays","PX-LH80181","CDM",80181,"CPT",300,"RC",{"$nulls":6},"both",null,null,55.92,55.92,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Interleukin 6","PX-LH83529","CDM",83529,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Resp Syncytial Virus Ag Ia","PX-LH87420","CDM",87420,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.73,41.73,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Assay of Estrone","PX-LH82679","CDM",82679,"CPT",300,"RC",{"$nulls":6},"both",null,null,176,176,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Xr-Mandible <4 Views","PX-3200226","CDM",70100,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Lumbar Bending 4views","PX-3200027","CDM",72120,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Bone Survey Complete","PX-3200215","CDM",77075,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["NM Brain Flow Image","PX-3410052","CDM",78610,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500001","CDM",70491,"CPT",350,"RC",{"$nulls":6},"both",null,null,1690,1690,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Multiple Gestation(<14 Wks)","PX-4020014","CDM",76802,"CPT",402,"RC",{"$nulls":6},"both",null,null,600,600,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Ortho Mgt/Training Initial","PX-4200012","CDM",97760,"CPT",420,"RC",{"$nulls":6},"both",null,null,139.86,139.86,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC S I Techniques 15 Min","PX-4300017","CDM",97533,"CPT",430,"RC",{"$nulls":6},"both",null,null,183.09,183.09,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Closed Rx MC-P Disloc","PX-4500029","CDM",26700,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Apply Short Leg Cast","PX-4500052","CDM",29405,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC I & D Abscess, Smpl","PX-4900003","CDM",10060,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Face,Facial","PX-4900039","CDM",11311,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Remaindr Bod","PX-4900050","CDM",11422,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Face,Facial","PX-4900078","CDM",11641,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 2.6-5","PX-4900115","CDM",12013,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Destroy Premlg Lesions 15+","PX-4900241","CDM",17004,"CPT",761,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Closed Rx Shldr Disloc,Anesthesia","PX-4900462","CDM",23655,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Injection Sacroiliac Joint","PX-4900724","CDM",27096,"CPT",761,"RC",{"$nulls":6},"both",null,null,1791.84,1791.84,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Explor Metatarso-Phalang Jt","PX-4900867","CDM",28022,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Rpr Inguinal Hernia,Reduce","PX-4902265","CDM",49520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Incision & Removal Foreign Body Subq Tiss Simple","PX-10120","CDM",10120,"CPT",982,"RC",{"$nulls":6},"both",null,null,441.78,441.78,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},102.08,147.92,null,null,"facility"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm","PX-11301","CDM",11301,"CPT",982,"RC",{"$nulls":6},"both",null,null,352.47,352.47,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},48.19,117.93,null,null,"facility"]
["HC Intercostal Nerve Block,Mlt","PX-4901669","CDM",64421,"CPT",360,"RC",{"$nulls":6},"both",null,null,2670.87,2670.87,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 2.1-3.0cm","PX-11423","CDM",11423,"CPT",982,"RC",{"$nulls":6},"both",null,null,592.65,592.65,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},150.94,198.74,null,null,"facility"]
["HC Incise Eardrum,Aspir,Gen Anesth","PX-4901890","CDM",69421,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",982,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},296,427.96,null,null,"facility"]
["Mra-Neck","PX-6100006","CDM",70547,"CPT",610,"RC",{"$nulls":6},"both",null,null,3400,3400,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["MRI-Brain/Brain Stem","PX-6110001","CDM",70551,"CPT",611,"RC",{"$nulls":6},"both",null,null,1590,1590,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Colonoscopy","PX-7500036","CDM",45384,"CPT",360,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Venous Imaging","PX-9210020","CDM",93970,"CPT",921,"RC",{"$nulls":6},"both",null,null,725.16,725.16,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Cardiac Rehab/Phase I Non-Monitored","PX-9430000","CDM",93797,"CPT",943,"RC",{"$nulls":6},"both",null,null,377.7,377.7,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 20.1-30.0cm","PX-12006","CDM",12006,"CPT",982,"RC",{"$nulls":6},"both",null,null,576.57,576.57,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},105.86,194.27,null,null,"facility"]
["Repair Complex Trunk 1.1-2.5 Cm","PX-13100","CDM",13100,"CPT",982,"RC",{"$nulls":6},"both",null,null,981.84,981.84,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},189.8,328.96,null,null,"facility"]
["Destruction Benign Lesions Up to 14","PX-17110","CDM",17110,"CPT",982,"RC",{"$nulls":6},"both",null,null,332.7,332.7,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},66.67,94.53,null,null,"facility"]
["HC Neg Pressure Wound Tx,< 50 Cm","PX-4200100","CDM",97605,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Co 2","PX-LH300016","CDM",82374,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Culture Fluid Ref","PX-LH300051","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Mono","PX-LH300077","CDM",86308,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Aldosterone-Uri","PX-LH300126","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Caffine Ref","PX-LH300138","CDM",86304,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Estrogen Total Ref","PX-LH300163","CDM",82672,"CPT",300,"RC",{"$nulls":6},"both",null,null,65.1,65.1,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Ibc","PX-LH300198","CDM",83550,"CPT",300,"RC",{"$nulls":6},"both",null,null,72,72,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Neurontin (Gaba)","PX-LH300221","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Quinidin Ref","PX-LH300337","CDM",80194,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.8,43.8,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Tbg Ref","PX-LH300348","CDM",84442,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.34,44.34,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Parasite ID Re","PX-LH300371","CDM",87999,"CPT",300,"RC",{"$nulls":6},"both",null,null,218.8,218.8,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Cryoglobulins Qual/Semi-Quant","PX-LH300405","CDM",82595,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.41,19.41,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Heavy Metal Urin Arsenic","PX-LH300428","CDM",82175,"CPT",300,"RC",{"$nulls":6},"both",null,null,149,149,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Tobramycin Trough Ref","PX-LH300448","CDM",80200,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.39,48.39,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Factor V Mut","PX-LH300486","CDM",81241,"CPT",300,"RC",{"$nulls":6},"both",null,null,170,170,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Pro-3 Cmp","PX-LH300510","CDM",80053,"CPT",300,"RC",{"$nulls":6},"both",null,null,82,82,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Ebv,Capsid HB, Igm Ref.","PX-LH300533","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Mycobacteria D-Probe Ref Infectious Agent Detection by Nucleic Acid (Dna or Rna)","PX-LH300544","CDM",87556,"CPT",300,"RC",{"$nulls":6},"both",null,null,125.04,125.04,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Glucose, Fluid Excl Blood Ref","PX-LH300567","CDM",82945,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh T3 Total Ref","PX-LH300604","CDM",84480,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Ld Iso Enzyme Ref","PX-LH300626","CDM",83625,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.37,38.37,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Cmv Quant Ref","PX-LH300649","CDM",87497,"CPT",300,"RC",{"$nulls":6},"both",null,null,343,343,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Sensory Neuropathy Profile Ref","PX-LH300660","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Factor X (10) Ref","PX-LH300682","CDM",85260,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Anaplasma Phagocytophilum Ref","PX-LH300717","CDM",86666,"CPT",300,"RC",{"$nulls":6},"both",null,null,79,79,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Mi-2 Auto Antibody Ref","PX-LH300738","CDM","LH300738","LOCAL",300,"RC",{"$nulls":6},"both",null,null,175,175,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Tissue Level 3 X3 Ref","PX-LH300764","CDM",88304,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Nucleic Acid, High Resolute Amp","PX-LH700005","CDM",87801,"CPT",300,"RC",{"$nulls":6},"both",null,null,210.6,210.6,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Knee Brace(Immobilizer)","PX-LH201360","CDM","LH201360","LOCAL",270,"RC",{"$nulls":6},"both",null,null,67.62,67.62,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Hourly Observation W/Monitor","PX-7621000","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,1118,1118,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["US Procedure,Unlisted","PX-4021000","CDM",76999,"CPT",402,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Anesthesia Hernia Rpr Upper Abd","PX-LH4400750","CDM",750,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Physician E&M Visit,Trmt Room","PX-LH62212","CDM",99212,"CPT",761,"RC",{"$nulls":6},"both",null,null,70.86,70.86,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Trauma Activation Level IV Assoc W/ Critical","PX-LHG0390L4","CDM","G0390","HCPCS",684,"RC",{"$nulls":6},"both",null,null,9000,9000,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["IBUPROFEN 100 MG/5ML PO SUSP","RX-10246","CDM","J3490","HCPCS",250,"RC","00904-5309-20","NDC",{"$nulls":4},"both",120,"ML",18.5,18.5,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["LABETALOL HCL 5 MG/ML IV SOLN","RX-10372","CDM","J1920","HCPCS",250,"RC","72266-0102-01","NDC",{"$nulls":4},"both",20,"ML",42.25,42.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["LIDOCAINE HCL (PF) 2 % INJ SOLN","RX-106254","CDM","J2003","HCPCS",636,"RC","63323-0495-27","NDC",{"$nulls":4},"both",2,"ML",23,23,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["MEDIHONEY WOUND/BURN DRESSING EX GEL","RX-110566","CDM",2500006,"HCPCS",250,"RC","09958-0034-60","NDC",{"$nulls":4},"both",15,"ML",27.25,27.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["TETANUS-DIPHTHERIA TOXOIDS TD 5-2 LFU IM INJ","RX-11515","CDM",90714,"HCPCS",636,"RC","49281-0215-10","NDC",{"$nulls":4},"both",0.5,"ML",44,44,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["MORPHINE SULFATE ER 15 MG PO TBCR","RX-123107","CDM",6370005,"HCPCS",250,"RC","42858-0801-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CETIRIZINE HCL 5 MG/5ML PO SOLN","RX-127424","CDM",6370005,"HCPCS",250,"RC","51672-2102-08","NDC",{"$nulls":4},"both",120,"ML",15.75,15.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["FLUCONAZOLE 150 MG PO TABS","RX-13577","CDM",6370005,"HCPCS",250,"RC","57237-0005-11","NDC",{"$nulls":4},"both",1,"UN",6.75,6.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["BACLOFEN 5 MG PO TABS","RX-142513","CDM",6370005,"HCPCS",250,"RC","71930-0066-12","NDC",{"$nulls":4},"both",1,"UN",5.25,5.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY","RX-144872","CDM","J2426","HCPCS",636,"RC","50458-0561-01","NDC",{"$nulls":4},"both",0.5,"ML",1575.75,1575.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["REMDESIVIR 100 MG IV SOLR","RX-148141","CDM","J0248","HCPCS",636,"RC","61958-2901-02","NDC",{"$nulls":4},"both",20,"ML",794.75,794.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["TRIPLE ANTIBIOTIC 5-400-5000 MG-UNIT EX OINT","RX-155859","CDM",2500006,"HCPCS",250,"RC","00713-0268-31","NDC",{"$nulls":4},"both",28.4,"GR",12,12,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CLONIDINE HCL 0.1 MG PO TABS","RX-1755","CDM",6370005,"HCPCS",250,"RC","60687-0113-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["ZINC OXIDE 40 % EX OINT","RX-19672","CDM",6370005,"HCPCS",250,"RC","63868-0593-57","NDC",{"$nulls":4},"both",28,"GR",10.75,10.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CITALOPRAM HYDROBROMIDE 20 MG PO TABS","RX-21062","CDM",6370005,"HCPCS",250,"RC","00378-6232-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["DIAZEPAM 5 MG/ML INJ SOLN","RX-2401","CDM","J3360","HCPCS",636,"RC","00409-1273-32","NDC",{"$nulls":4},"both",2,"ML",93.75,93.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["PANTOPRAZOLE SODIUM 20 MG PO TBEC","RX-26224","CDM",6370005,"HCPCS",250,"RC","00008-0843-81","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["FENTANYL 50 MCG/HR TD PT72","RX-27906","CDM",6370005,"HCPCS",250,"RC","00378-9122-98","NDC",{"$nulls":4},"both",1,"UN",48.75,48.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["VALSARTAN 160 MG PO TABS","RX-31210","CDM",6370005,"HCPCS",250,"RC","60687-0634-11","NDC",{"$nulls":4},"both",1,"UN",8.75,8.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["VALSARTAN 40 MG PO TABS","RX-33541","CDM",6370005,"HCPCS",250,"RC","67877-0415-30","NDC",{"$nulls":4},"both",1,"UN",4,4,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HYDROCORTISONE 20 MG PO TABS","RX-3734","CDM",6370005,"HCPCS",250,"RC","00115-1700-01","NDC",{"$nulls":4},"both",1,"UN",4,4,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["LEVOTHYROXINE SODIUM 50 MCG PO TABS","RX-4421","CDM",6370005,"HCPCS",250,"RC","00527-3281-46","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CHLOROPROCAINE 2% BUFFERED WITH SOD BICARBONATE INJECTION","RX-452052","CDM","J2400","HCPCS",636,"RC",{"$nulls":6},"both",40,"ML",89.25,89.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN","RX-5474","CDM",6370005,"HCPCS",250,"RC","24208-0790-62","NDC",{"$nulls":4},"both",10,"ML",159,159,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["PROMETHAZINE HCL 25 MG/ML INJ SOLN","RX-6618","CDM","J2550","HCPCS",636,"RC","00641-6208-25","NDC",{"$nulls":4},"both",1,"ML",23,23,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["SODIUM BICARBONATE 650 MG PO TABS","RX-7313","CDM",6370005,"HCPCS",250,"RC","00904-7261-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["GUAIFENESIN-CODEINE 100-10 MG/5ML PO SYRP","RX-78003","CDM",6370005,"HCPCS",250,"RC","00121-0775-04","NDC",{"$nulls":4},"both",118,"ML",482.5,482.5,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["GLUCOSE 40 % PO GEL","RX-81823","CDM",6370005,"HCPCS",250,"RC","00574-0069-15","NDC",{"$nulls":4},"both",45,"GR",63.5,63.5,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["ACYCLOVIR 5 % EX CREA","RX-8967","CDM",6370005,"HCPCS",250,"RC","00093-3630-20","NDC",{"$nulls":4},"both",5,"GR",1610.25,1610.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["BUPROPION HCL 100 MG PO TABS","RX-9321","CDM",6370005,"HCPCS",250,"RC","50090-1869-00","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CIPROFLOXACIN HCL 0.3 % OP SOLN","RX-9610","CDM","J3490","HCPCS",250,"RC","61314-0656-25","NDC",{"$nulls":4},"both",2.5,"ML",20.25,20.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Special Stain-Group I","PX-401536070","CDM",88312,"CPT",312,"RC",{"$nulls":6},"both",null,null,160.29,160.29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Ultrasound of Extremity","PX-4020077","CDM",76881,"CPT",402,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Cltx Trimalleolar Ankle Fx W/Manipulation","PX-27818","CDM",27818,"CPT",982,"RC",{"$nulls":6},"both",null,null,1432.92,1432.92,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},427.8,482.81,null,null,"facility"]
["Application Short Arm Splint Forearm-Hand Static","PX-29125","CDM",29125,"CPT",982,"RC",{"$nulls":6},"both",null,null,195.9,195.9,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},38.52,65.7,null,null,"facility"]
["Lh Culture Screen Only","PX-LH300792","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Strapping Low Back","PX-4903034","CDM",29799,"CPT",360,"RC",{"$nulls":6},"both",null,null,450.39,450.39,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["C1 Esterase Inhibitor,Protein","PX-LH300847","CDM",86160,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Tpmt Activity Mass Spectometry","PX-LH300822","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",975,"RC",{"$nulls":6},"both",null,null,654,654,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},220.52,220.52,null,null,"facility"]
["Colectomy Partial W/Anastomosis","PX-44140","CDM",44140,"CPT",975,"RC",{"$nulls":6},"both",null,null,3622.2,3622.2,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},1231.05,1231.05,null,null,"facility"]
["Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn","PX-62321","CDM",62321,"CPT",975,"RC",{"$nulls":6},"both",null,null,763.53,763.53,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},101.78,255.35,null,null,"facility"]
["Lh Varicella-Zoster Virus Ab Acif","PX-LH300882","CDM",86787,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Xray Chest 2 Views","PX-3240021","CDM",71046,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Fish Bcr/Abl IP Situ 100-200 Cells Ref","PX-LH300981","CDM",88275,"CPT",300,"RC",{"$nulls":6},"both",null,null,153.57,153.57,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Amino Acid Analysis 2 to 5 Quant Ea Specmn","PX-LH300988","CDM",82136,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Incisional Bx Sngl Skin Lesion","PX-4903281","CDM",11106,"CPT",761,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Intercostal Nrv Single Lvl","PX-64420","CDM",64420,"CPT",975,"RC",{"$nulls":6},"both",null,null,282.72,282.72,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},55.07,94.69,null,null,"facility"]
["Lh Acetylcholine Receptor Blocking Antibody","PX-LH301035","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img","PX-64451","CDM",64451,"CPT",975,"RC",{"$nulls":6},"both",null,null,663.42,663.42,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},77.35,221.76,null,null,"facility"]
["Lh Arsenic","PX-LH301055","CDM",82175,"CPT",300,"RC",{"$nulls":6},"both",null,null,149,149,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Ext Ecg >7d<15d Recording","PX-7310017","CDM",93246,"CPT",360,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Im Adm Prq ID Subq/Im Njxs 1 Vaccine","PX-90471","CDM",90471,"CPT",982,"RC",{"$nulls":6},"both",null,null,60.3,60.3,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},20.14,20.14,null,null,"facility"]
["Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj","PX-94010","CDM",94010,"CPT",982,"RC",{"$nulls":6},"both",null,null,79.35,79.35,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},7.7,26.53,null,null,"facility"]
["Lh Blood Count; Hematocrit (Hct)","PX-LH85014","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Clot Factor VIII Multimetric","PX-LH85247","CDM",85247,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Assay of Estrone","PX-LH82679","CDM",82679,"CPT",300,"RC",{"$nulls":6},"both",null,null,176,176,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Xr-Mandible <4 Views","PX-3200226","CDM",70100,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Lumbar Bending 4views","PX-3200027","CDM",72120,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Xray Humerus","PX-3200047","CDM",73060,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Bone Survey Lmtd","PX-3200214","CDM",77074,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500001","CDM",70491,"CPT",350,"RC",{"$nulls":6},"both",null,null,1690,1690,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CT-Ear","PX-3510005","CDM",70482,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["US OB Complete(<14 Wks)","PX-4020013","CDM",76801,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC S I Techniques 15 Min","PX-4300017","CDM",97533,"CPT",430,"RC",{"$nulls":6},"both",null,null,183.09,183.09,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Closed Rx Mid Humerus Fracture","PX-4500016","CDM",24500,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Fibula Fx","PX-4500105","CDM",27786,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Remv Ext Canal Foreign Body","PX-4500090","CDM",69200,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Stress Test","PX-4820000","CDM",93017,"CPT",482,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Remaindr Bod","PX-4900050","CDM",11422,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Face,Facial","PX-4900078","CDM",11641,"CPT",761,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 2.6-5","PX-4900115","CDM",12013,"CPT",450,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 7.6-12.5","PX-4900128","CDM",12044,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Destruct Premalg Les, 2-14","PX-4900240","CDM",17003,"CPT",761,"RC",{"$nulls":6},"both",null,null,84.94,84.94,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx,Manipul","PX-4900575","CDM",25605,"CPT",450,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Explor Metatarso-Phalang Jt","PX-4900867","CDM",28022,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Esophagoscopy","PX-4902014","CDM",43200,"CPT",360,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Hemorrhoidectomy External","PX-4902150","CDM",46250,"CPT",761,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Biopsy of Uterus Lining","PX-4901558","CDM",58100,"CPT",761,"RC",{"$nulls":6},"both",null,null,569.58,569.58,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Spinal Puncture","PX-4901628","CDM",62270,"CPT",450,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Celiac Plexus Nerve Block","PX-4901685","CDM",64530,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Glaucoma Surg,Trabecu Ab Externo","PX-4901766","CDM",66170,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",982,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},296,427.96,null,null,"facility"]
["Mra-Neck","PX-6100006","CDM",70547,"CPT",610,"RC",{"$nulls":6},"both",null,null,3400,3400,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["MRI-Brain/Brain Stem","PX-6110001","CDM",70551,"CPT",611,"RC",{"$nulls":6},"both",null,null,1590,1590,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["L-Spine","PX-6120008","CDM",72158,"CPT",612,"RC",{"$nulls":6},"both",null,null,2810,2810,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Colonoscopy,Submucous Inj","PX-7500034","CDM",45381,"CPT",750,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Injection","PX-9400009","CDM",96372,"CPT",260,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 20.1-30.0cm","PX-12006","CDM",12006,"CPT",982,"RC",{"$nulls":6},"both",null,null,576.57,576.57,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},105.86,194.27,null,null,"facility"]
["Repair Complex Trunk 1.1-2.5 Cm","PX-13100","CDM",13100,"CPT",982,"RC",{"$nulls":6},"both",null,null,981.84,981.84,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},189.8,328.96,null,null,"facility"]
["Repair Complx Eyelid/Nose/Ear/Lip Ea Addl 5 Cm/<","PX-13153","CDM",13153,"CPT",982,"RC",{"$nulls":6},"both",null,null,521.76,521.76,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},126.76,175.55,null,null,"facility"]
["Destruction Premalignant Lesion 15/>","PX-17004","CDM",17004,"CPT",982,"RC",{"$nulls":6},"both",null,null,486,486,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},94.22,162.66,null,null,"facility"]
["Lh Amylase","PX-LH300017","CDM",82150,"CPT",300,"RC",{"$nulls":6},"both",null,null,51,51,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Calcium Total","PX-LH300028","CDM",82310,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Gram Stain","PX-LH300047","CDM",87205,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Bld Type Rh","PX-LH300094","CDM",86901,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.25,39.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Caffine Ref","PX-LH300138","CDM",86304,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Estrogen Total Ref","PX-LH300163","CDM",82672,"CPT",300,"RC",{"$nulls":6},"both",null,null,65.1,65.1,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Free T4 Ref","PX-LH300174","CDM",84439,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Hydroxproline Total U","PX-LH300197","CDM",83505,"CPT",300,"RC",{"$nulls":6},"both",null,null,72.9,72.9,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Extractable Antigen Sm/Rnp Ref","PX-LH300300","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Tbg Ref","PX-LH300348","CDM",84442,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.34,44.34,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Parasite ID Re","PX-LH300371","CDM",87999,"CPT",300,"RC",{"$nulls":6},"both",null,null,218.8,218.8,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Cmv Ab, Igg, Se","PX-LH300382","CDM",86644,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Eosinophil Coun","PX-LH300404","CDM",85008,"CPT",300,"RC",{"$nulls":6},"both",null,null,10.29,10.29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Wet Mount","PX-LH300426","CDM",87210,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Tacrolimus","PX-LH300462","CDM",80197,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Anti-Phospholipid Panel Ref","PX-LH300478","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Psa Hyb, Total Diagnostic","PX-LH300521","CDM",84153,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Mycobacteria D-Probe Ref Infectious Agent Detection by Nucleic Acid (Dna or Rna)","PX-LH300544","CDM",87556,"CPT",300,"RC",{"$nulls":6},"both",null,null,125.04,125.04,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Glucose, Fluid Excl Blood Ref","PX-LH300567","CDM",82945,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Total Protien Ua, Random Ref Serum, Plasma, or Whole Blood","PX-LH300579","CDM",84155,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Cortisone Ref Mass Spectometry","PX-LH300603","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Hcg Serum Qualitative Ref","PX-LH300638","CDM",84703,"CPT",300,"RC",{"$nulls":6},"both",null,null,59,59,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Sensory Neuropathy Profile Ref","PX-LH300660","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Factor X (10) Ref","PX-LH300682","CDM",85260,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Iga Subclasses Ref","PX-LH300694","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Babesia Ab","PX-LH300716","CDM",86753,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Mi-2 Auto Antibody Ref","PX-LH300738","CDM","LH300738","LOCAL",300,"RC",{"$nulls":6},"both",null,null,175,175,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Testesterone Bio Ref","PX-LH300776","CDM",82040,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Iga Subclasses Ref","PX-LH300964","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Tegaderm","PX-LH202360","CDM","LH202360","LOCAL",270,"RC",{"$nulls":6},"both",null,null,5.25,5.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["US Procedure,Unlisted","PX-4021000","CDM",76999,"CPT",402,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Anesthesia Hernia Rpr Upper Abd","PX-LH4400750","CDM",750,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Anesthesia T&A","PX-LH4400170","CDM",170,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Flu Vaccine Administration","PX-LH260008","CDM",90471,"CPT",771,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Trauma Activation Level III Assoc W/ Crit Care","PX-LHG0390L3","CDM","G0390","HCPCS",683,"RC",{"$nulls":6},"both",null,null,9000,9000,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["LABETALOL HCL 5 MG/ML IV SOLN","RX-10372","CDM","J1920","HCPCS",250,"RC","72266-0102-01","NDC",{"$nulls":4},"both",20,"ML",42.25,42.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["LIDOCAINE HCL (PF) 2 % INJ SOLN","RX-106254","CDM","J2003","HCPCS",636,"RC","63323-0495-27","NDC",{"$nulls":4},"both",2,"ML",23,23,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["BUPIVACAINE HCL (PF) 0.5 % INJ SOLN","RX-108769","CDM","J0665","HCPCS",636,"RC","63323-0466-17","NDC",{"$nulls":4},"both",10,"ML",23,23,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["PROCHLORPERAZINE 25 MG REC SUPP","RX-11138","CDM",6370005,"HCPCS",250,"RC","00713-0135-12","NDC",{"$nulls":4},"both",1,"UN",4.5,4.5,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["TIMOLOL MALEATE 0.5 % OP SOLN","RX-11562","CDM",6370005,"HCPCS",250,"RC","61314-0227-05","NDC",{"$nulls":4},"both",5,"ML",26.75,26.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["TOBRAMYCIN 0.3 % OP SOLN","RX-127425","CDM",2500005,"HCPCS",250,"RC","62332-0518-05","NDC",{"$nulls":4},"both",5,"ML",30.25,30.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["EMPAGLIFLOZIN 10 MG PO TABS","RX-129061","CDM",6370005,"HCPCS",250,"RC","00597-0152-30","NDC",{"$nulls":4},"both",1,"UN",62.75,62.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["INSULIN DEGLUDEC 100 UNIT/ML SC SOPN","RX-133544","CDM",6360000,"HCPCS",636,"RC","00169-2660-15","NDC",{"$nulls":4},"both",3,"ML",177.75,177.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["PALIPERIDONE PALMITATE ER 78 MG/0.5ML IM SUSY","RX-144872","CDM","J2426","HCPCS",636,"RC","50458-0561-01","NDC",{"$nulls":4},"both",0.5,"ML",1575.75,1575.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["REMDESIVIR 100 MG IV SOLR","RX-148141","CDM","J0248","HCPCS",636,"RC","61958-2901-02","NDC",{"$nulls":4},"both",20,"ML",794.75,794.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["SUMATRIPTAN SUCCINATE 50 MG PO TABS","RX-15328","CDM",6370005,"HCPCS",250,"RC","65862-0147-36","NDC",{"$nulls":4},"both",1,"UN",18.25,18.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CALCIUM CITRATE-VITAMIN D 200-6.25 MG-MCG PO TABS","RX-155234","CDM",6370005,"HCPCS",250,"RC","16500-0535-02","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["MIRTAZAPINE 15 MG PO TABS","RX-17466","CDM",6370005,"HCPCS",250,"RC","63739-0098-10","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CITALOPRAM HYDROBROMIDE 20 MG PO TABS","RX-21062","CDM",6370005,"HCPCS",250,"RC","00378-6232-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["DIAZEPAM 5 MG/ML INJ SOLN","RX-2401","CDM","J3360","HCPCS",636,"RC","00409-1273-32","NDC",{"$nulls":4},"both",2,"ML",93.75,93.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","RX-24984","CDM",6370005,"HCPCS",250,"RC","00113-0306-02","NDC",{"$nulls":4},"both",238,"GR",892.5,892.5,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CEFEPIME HCL 2 G IV SOLR","RX-27311","CDM","J0692","HCPCS",636,"RC","60505-6246-00","NDC",{"$nulls":4},"both",2,"GR",85.5,85.5,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["FENOFIBRATE 160 MG PO TABS","RX-28252","CDM",6370005,"HCPCS",250,"RC","00115-5522-10","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["GEMFIBROZIL 600 MG PO TABS","RX-3378","CDM",6370005,"HCPCS",250,"RC","60687-0224-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["GLYCOPYRROLATE 0.2 MG/ML INJ SOLN","RX-3497","CDM","J1598","HCPCS",636,"RC","63323-0578-03","NDC",{"$nulls":4},"both",1,"ML",47,47,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["DULOXETINE HCL 30 MG PO CPEP","RX-39276","CDM",6370005,"HCPCS",250,"RC","57237-0018-30","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["MIDAZOLAM HCL 2 MG/2ML INJ SOLN","RX-40872","CDM","J2250","HCPCS",636,"RC","00641-6209-25","NDC",{"$nulls":4},"both",2,"ML",23,23,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75-10000-.025 OP SOLN","RX-5474","CDM",6370005,"HCPCS",250,"RC","24208-0790-62","NDC",{"$nulls":4},"both",10,"ML",159,159,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["OXYTOCIN 10 UNIT/ML INJ SOLN","RX-5944","CDM","J2590","HCPCS",636,"RC","63323-0012-03","NDC",{"$nulls":4},"both",1,"ML",23,23,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["PREDNISONE 5 MG PO TABS","RX-6497","CDM","J7512","HCPCS",636,"RC","00054-8724-25","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["SODIUM BICARBONATE 4.2 % IV SOLN","RX-7306","CDM",2500006,"HCPCS",250,"RC","00409-5555-02","NDC",{"$nulls":4},"both",5,"ML",30.25,30.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["GLUCOSE 40 % PO GEL","RX-81823","CDM",6370005,"HCPCS",250,"RC","00574-0069-15","NDC",{"$nulls":4},"both",45,"GR",63.5,63.5,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["ACYCLOVIR 5 % EX CREA","RX-8967","CDM",6370005,"HCPCS",250,"RC","00093-3630-20","NDC",{"$nulls":4},"both",5,"GR",1610.25,1610.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G INJ SOLR","RX-9083","CDM","J0295","HCPCS",636,"RC","71288-0031-20","NDC",{"$nulls":4},"both",1.5,"GR",23,23,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CAPTOPRIL 12.5 MG PO TABS","RX-9401","CDM",6370005,"HCPCS",250,"RC","00143-1171-01","NDC",{"$nulls":4},"both",1,"UN",5,5,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CIPROFLOXACIN HCL 0.3 % OP SOLN","RX-9610","CDM","J3490","HCPCS",250,"RC","61314-0656-25","NDC",{"$nulls":4},"both",2.5,"ML",20.25,20.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Inject Si Joint Arthrgrphy&/Anes/Steroid W/Ima","PX-27096","CDM",27096,"CPT",982,"RC",{"$nulls":6},"both",null,null,475.8,475.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},78.66,159.21,null,null,"facility"]
["Cltx Metatarsophlngl Jt Dislc W/O Anes","PX-28630","CDM",28630,"CPT",521,"RC",{"$nulls":6},"both",null,null,448.26,448.26,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},106.08,150.61,null,null,"facility"]
["Application Short Arm Splint Forearm-Hand Static","PX-29125","CDM",29125,"CPT",982,"RC",{"$nulls":6},"both",null,null,195.9,195.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},38.52,65.7,null,null,"facility"]
["Ht Muscle Image Spect,Multiple","PX-3410073","CDM",78452,"CPT",341,"RC",{"$nulls":6},"both",null,null,3916.44,3916.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Mercury Quant","PX-LH300797","CDM",83825,"CPT",300,"RC",{"$nulls":6},"both",null,null,126,126,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Anesthesia Repair of Hernia V&a Lwr Abd","PX-LH4400832","CDM",832,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Chemodenervation One Extremity 1-4 Muscle","PX-64642","CDM",64642,"CPT",975,"RC",{"$nulls":6},"both",null,null,429.54,429.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},99.11,144.95,null,null,"facility"]
["Lh Anesthesia,Surgery Intraperitoneal Upper Abdomen","PX-LH4400790","CDM",790,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Colectomy Partial W/Anastomosis","PX-44140","CDM",44140,"CPT",975,"RC",{"$nulls":6},"both",null,null,3622.2,3622.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},1231.05,1231.05,null,null,"facility"]
["Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn","PX-62321","CDM",62321,"CPT",975,"RC",{"$nulls":6},"both",null,null,763.53,763.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},101.78,255.35,null,null,"facility"]
["Lh Anti-Mullerian Hormone","PX-LH300877","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Laps Surg Rpr Recurrent Inguinal Hernia","PX-49651","CDM",49651,"CPT",975,"RC",{"$nulls":6},"both",null,null,1552.44,1552.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},526.89,526.89,null,null,"facility"]
["HC Xray Chest 2 Views","PX-3240021","CDM",71046,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh O&P Smear,Complex Stain","PX-LH300979","CDM",87209,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Incisional Bx Sngl Skin Lesion","PX-4903281","CDM",11106,"CPT",761,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Intercostal Nrv Single Lvl","PX-64420","CDM",64420,"CPT",975,"RC",{"$nulls":6},"both",null,null,282.72,282.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},55.07,94.69,null,null,"facility"]
["Injx Anes Celiac Plexus W/WO Radiologic Monitrng","PX-64530","CDM",64530,"CPT",975,"RC",{"$nulls":6},"both",null,null,664.77,664.77,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},89.97,222.25,null,null,"facility"]
["Lh Acetylcholine Receptor Modulating Antibody","PX-LH301034","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Cdsm Medicalis","PX-3201003","CDM","G1003","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Aspergillus Fumigatus (M3) Igg","PX-LH301065","CDM",86001,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Ext Ecg >48hr<7d Recording","PX-7310013","CDM",93242,"CPT",761,"RC",{"$nulls":6},"both",null,null,114.63,114.63,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj","PX-94010","CDM",94010,"CPT",982,"RC",{"$nulls":6},"both",null,null,79.35,79.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},7.7,26.53,null,null,"facility"]
["Lh Blood Count; Hematocrit (Hct)","PX-LH85014","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Interleukin 6","PX-LH83529","CDM",83529,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Lactoferrin Fecal (Quant)","PX-LH83631","CDM",83631,"CPT",300,"RC",{"$nulls":6},"both",null,null,157,157,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Assay of Estrone","PX-LH82679","CDM",82679,"CPT",300,"RC",{"$nulls":6},"both",null,null,176,176,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Room & Nursing","PX-1210000","CDM",null,null,120,"RC",{"$nulls":6},"both",null,null,4652.5,4652.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Xray Humerus","PX-3200047","CDM",73060,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Bone Survey Lmtd","PX-3200214","CDM",77074,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3310001","CDM",96402,"CPT",331,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500000","CDM",70490,"CPT",350,"RC",{"$nulls":6},"both",null,null,1420,1420,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520008","CDM",74160,"CPT",350,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["US Scrotum","PX-4020026","CDM",76870,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Therapy Activity 15min","PX-4300015","CDM",97530,"CPT",430,"RC",{"$nulls":6},"both",null,null,107.46,107.46,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Fibula Fx","PX-4500105","CDM",27786,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Remv Ext Canal Foreign Body","PX-4500090","CDM",69200,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC I & D Abscess, Smpl","PX-4900003","CDM",10060,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Removal of Skin Tags","PX-4900028","CDM",11200,"CPT",761,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Remaindr Bod","PX-4900050","CDM",11422,"CPT",761,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 1.1-2cm Remaindr Bod","PX-4900073","CDM",11622,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 7.6-12.5","PX-4900128","CDM",12044,"CPT",450,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Destruct Premalg Les, 2-14","PX-4900240","CDM",17003,"CPT",761,"RC",{"$nulls":6},"both",null,null,84.94,84.94,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Inj Tendon Sheath/Ligament","PX-4900317","CDM",20550,"CPT",761,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx","PX-4900574","CDM",25600,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Closed Rx Ankle Dislocatn","PX-4900854","CDM",27840,"CPT",450,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Hemorrhoidectomy External","PX-4902150","CDM",46250,"CPT",761,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Incision & Drainage Pilonidal Cyst Simple","PX-10080","CDM",10080,"CPT",982,"RC",{"$nulls":6},"both",null,null,728.52,728.52,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},100.96,243.73,null,null,"facility"]
["HC Removal of Testis Smpl","PX-4901466","CDM",54520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9964.74,9964.74,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Celiac Plexus Nerve Block","PX-4901685","CDM",64530,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 2.1-3.0cm","PX-11423","CDM",11423,"CPT",982,"RC",{"$nulls":6},"both",null,null,592.65,592.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},150.94,198.74,null,null,"facility"]
["HC Excis Chalazion,Single","PX-4901818","CDM",67800,"CPT",360,"RC",{"$nulls":6},"both",null,null,832.68,832.68,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",982,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},296,427.96,null,null,"facility"]
["HC Special Care Transport","PX-5420006","CDM","A0434","HCPCS",540,"RC",{"$nulls":6},"both",null,null,2735.97,2735.97,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["L-Spine","PX-6120008","CDM",72158,"CPT",612,"RC",{"$nulls":6},"both",null,null,2810,2810,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Colonoscopy,Submucous Inj","PX-7500034","CDM",45381,"CPT",750,"RC",{"$nulls":6},"both",null,null,3373.08,3373.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Gastric Intubat Dx W/Aspiration Single Specimen","PX-43754","CDM",43754,"CPT",975,"RC",{"$nulls":6},"both",null,null,684.51,684.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},35.75,228.61,null,null,"facility"]
["Infusion","PX-9400008","CDM",96368,"CPT",260,"RC",{"$nulls":6},"both",null,null,612.66,612.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 12.6-20.0cm","PX-12005","CDM",12005,"CPT",982,"RC",{"$nulls":6},"both",null,null,500.28,500.28,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},86.34,168.53,null,null,"facility"]
["Repair Complx Eyelid/Nose/Ear/Lip Ea Addl 5 Cm/<","PX-13153","CDM",13153,"CPT",982,"RC",{"$nulls":6},"both",null,null,521.76,521.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},126.76,175.55,null,null,"facility"]
["Destruction Premalignant Lesion 15/>","PX-17004","CDM",17004,"CPT",982,"RC",{"$nulls":6},"both",null,null,486,486,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},94.22,162.66,null,null,"facility"]
["Injection Single Tendon Origin/Insertion","PX-20551","CDM",20551,"CPT",982,"RC",{"$nulls":6},"both",null,null,164.49,164.49,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},36.23,55.22,null,null,"facility"]
["Lh Hct","PX-LH300004","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Culture Fluid Ref","PX-LH300051","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Sensitivity Ea Multi-Antimicrob per Plate","PX-LH300062","CDM",87186,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Bld Type Rh","PX-LH300094","CDM",86901,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.25,39.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Cortisol Free-Urine","PX-LH300153","CDM",82530,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.13,50.13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Free T4 Ref","PX-LH300174","CDM",84439,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hydroxproline Total U","PX-LH300197","CDM",83505,"CPT",300,"RC",{"$nulls":6},"both",null,null,72.9,72.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Lh Ref","PX-LH300209","CDM",83002,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Anaplasma Pcr Amp Ref","PX-LH300299","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Strep Screen Ref","PX-LH300347","CDM",87880,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.59,49.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Cmv Ab, Igg, Se","PX-LH300382","CDM",86644,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Eosinophil Coun","PX-LH300404","CDM",85008,"CPT",300,"RC",{"$nulls":6},"both",null,null,10.29,10.29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Neut Cytoplasmi","PX-LH300415","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hepatitis B Cor","PX-LH300437","CDM",86704,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Cortisol Stimul","PX-LH300461","CDM",80400,"CPT",300,"RC",{"$nulls":6},"both",null,null,97.86,97.86,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Tis Transflut A","PX-LH300498","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Psa Hyb, Total Diagnostic","PX-LH300521","CDM",84153,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Influenza B","PX-LH300551","CDM",87804,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Total Protien Ua, Random Ref Serum, Plasma, or Whole Blood","PX-LH300579","CDM",84155,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Cortisone Ref Mass Spectometry","PX-LH300603","CDM",83789,"CPT",300,"RC",{"$nulls":6},"both",null,null,141,141,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Carbamazepine Free Reff","PX-LH300614","CDM",80156,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.71,43.71,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Antiphospholipid Panel Ref","PX-LH300637","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Pyridoine Pyridoxal Vit B6 Ref","PX-LH300659","CDM",84207,"CPT",300,"RC",{"$nulls":6},"both",null,null,218,218,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Iga Subclasses Ref","PX-LH300694","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Babesia Ab","PX-LH300716","CDM",86753,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Pro-10(Chol/Ldl)","PX-LH300727","CDM",82465,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Peanut Ige Ref","PX-LH300753","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Cortisol Free 24hr Ua Ref","PX-LH300775","CDM",82530,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.13,50.13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Cervical Collar","PX-LH200520","CDM","LH200520","LOCAL",270,"RC",{"$nulls":6},"both",null,null,18.57,18.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Tegaderm","PX-LH202360","CDM","LH202360","LOCAL",270,"RC",{"$nulls":6},"both",null,null,5.25,5.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Ekg-12 Leads-Ippe","PX-7300006","CDM","G0403","HCPCS",730,"RC",{"$nulls":6},"both",null,null,41.04,41.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Anesthesia T&A","PX-LH4400170","CDM",170,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Flu Vaccine Administration","PX-LH260008","CDM",90471,"CPT",771,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Pneumoccal Ppsv23 Vaccine 2/> Yo","PX-LH422425","CDM",90732,"CPT",636,"RC",{"$nulls":6},"both",null,null,400.41,400.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Drain/Inject Joint/Bursa","PX-4902716","CDM",20606,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["KETOROLAC TROMETHAMINE 10 MG PO TABS","RX-10371","CDM",6370005,"HCPCS",250,"RC","60687-0104-21","NDC",{"$nulls":4},"both",1,"UN",30.25,30.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["BUPIVACAINE HCL (PF) 0.5 % INJ SOLN","RX-108769","CDM","J0665","HCPCS",636,"RC","63323-0466-17","NDC",{"$nulls":4},"both",10,"ML",23,23,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["PROCHLORPERAZINE 25 MG REC SUPP","RX-11138","CDM",6370005,"HCPCS",250,"RC","00713-0135-12","NDC",{"$nulls":4},"both",1,"UN",4.5,4.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["SIMVASTATIN 10 MG PO TABS","RX-11364","CDM",6370005,"HCPCS",250,"RC","63739-0571-10","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","RX-120512","CDM","J2270","HCPCS",636,"RC","00641-6125-25","NDC",{"$nulls":4},"both",1,"ML",23,23,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CETIRIZINE HCL 5 MG/5ML PO SOLN","RX-127424","CDM",6370005,"HCPCS",250,"RC","51672-2102-08","NDC",{"$nulls":4},"both",120,"ML",15.75,15.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CALCIUM ACETATE (PHOS BINDER) 667 MG PO CAPS","RX-133644","CDM",6370005,"HCPCS",250,"RC","00054-0088-26","NDC",{"$nulls":4},"both",1,"UN",14.75,14.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["LEVONORGESTREL 19.5 MG IU IUD","RX-137553","CDM","J7296","HCPCS",636,"RC","50419-0424-01","NDC",{"$nulls":4},"both",20,"ME",5819.25,5819.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY","RX-144889","CDM","J2003","HCPCS",636,"RC","76329-3390-01","NDC",{"$nulls":4},"both",5,"ML",33.25,33.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["SUMATRIPTAN SUCCINATE 50 MG PO TABS","RX-15328","CDM",6370005,"HCPCS",250,"RC","65862-0147-36","NDC",{"$nulls":4},"both",1,"UN",18.25,18.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CALCIUM CITRATE-VITAMIN D 200-6.25 MG-MCG PO TABS","RX-155234","CDM",6370005,"HCPCS",250,"RC","16500-0535-02","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HEPARIN SODIUM (PORCINE) PF 1000 UNIT/ML INJ SOLN","RX-159611","CDM","J1644","HCPCS",250,"RC","63323-0276-02","NDC",{"$nulls":4},"both",2,"ML",53.5,53.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["RISPERIDONE 1 MG PO TABS","RX-18313","CDM",6370005,"HCPCS",250,"RC","68084-0272-01","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["LEUPROLIDE ACETATE (3 MONTH) 22.5 MG IM KIT","RX-21045","CDM","J9217","HCPCS",636,"RC","00074-3346-03","NDC",{"$nulls":4},"both",22.5,"ME",6710.5,6710.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","RX-24984","CDM",6370005,"HCPCS",250,"RC","00113-0306-02","NDC",{"$nulls":4},"both",238,"GR",892.5,892.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CEFEPIME HCL 2 G IV SOLR","RX-27311","CDM","J0692","HCPCS",636,"RC","60505-6246-00","NDC",{"$nulls":4},"both",2,"GR",85.5,85.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["FENOFIBRATE 160 MG PO TABS","RX-28252","CDM",6370005,"HCPCS",250,"RC","00115-5522-10","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["DILTIAZEM HCL ER COATED BEADS 180 MG PO CP24","RX-29272","CDM",6370005,"HCPCS",250,"RC","60687-0206-01","NDC",{"$nulls":4},"both",1,"UN",4.25,4.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["VALSARTAN 40 MG PO TABS","RX-33541","CDM",6370005,"HCPCS",250,"RC","67877-0415-30","NDC",{"$nulls":4},"both",1,"UN",4,4,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["PROPRANOLOL HCL ER 80 MG PO CP24","RX-38225","CDM",6370005,"HCPCS",250,"RC","00228-2779-11","NDC",{"$nulls":4},"both",1,"UN",13,13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["BENZOCAINE-MENTHOL 6-10 MG MT LOZG","RX-41085","CDM",6370005,"HCPCS",250,"RC","78112-0011-06","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["LISINOPRIL 20 MG PO TABS","RX-4526","CDM",6370005,"HCPCS",250,"RC","00904-6799-61","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["MAGNESIUM CITRATE PO SOLN","RX-4712","CDM",6370005,"HCPCS",250,"RC","63868-0935-10","NDC",{"$nulls":4},"both",296,"ML",8.5,8.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["PREDNISONE 5 MG PO TABS","RX-6497","CDM","J7512","HCPCS",636,"RC","00054-8724-25","NDC",{"$nulls":4},"both",1,"UN",3.75,3.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["ASPIRIN 300 MG REC SUPP","RX-693","CDM",6370005,"HCPCS",250,"RC","00574-7034-12","NDC",{"$nulls":4},"both",1,"UN",8.5,8.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["STREPTOMYCIN SULFATE 1 G IM SOLR","RX-7508","CDM","J3000","HCPCS",636,"RC","39822-0706-02","NDC",{"$nulls":4},"both",1000,"ME",46,46,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["DIPHENHYDRAMINE-PHENYLEPHRINE 12.5-5 MG/5ML PO SOLN","RX-81744","CDM",2500006,"HCPCS",250,"RC","00045-0170-05","NDC",{"$nulls":4},"both",118,"ML",28.5,28.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["AMPICILLIN-SULBACTAM SODIUM 1.5 (1-0.5) G INJ SOLR","RX-9083","CDM","J0295","HCPCS",636,"RC","71288-0031-20","NDC",{"$nulls":4},"both",1.5,"GR",23,23,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CAPTOPRIL 12.5 MG PO TABS","RX-9401","CDM",6370005,"HCPCS",250,"RC","00143-1171-01","NDC",{"$nulls":4},"both",1,"UN",5,5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CIPROFLOXACIN HCL 0.3 % OP SOLN","RX-9610","CDM","J3490","HCPCS",250,"RC","61314-0656-25","NDC",{"$nulls":4},"both",2.5,"ML",20.25,20.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["DRONABINOL 2.5 MG PO CAPS","RX-9904","CDM","Q0167","HCPCS",636,"RC","67877-0753-60","NDC",{"$nulls":4},"both",1,"UN",10.25,10.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Ultrasound of Extremity","PX-4020077","CDM",76881,"CPT",402,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Thyroid Imaging","PX-3410086","CDM",78014,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh PCP","PX-LH300832","CDM",83992,"CPT",300,"RC",{"$nulls":6},"both",null,null,176.09,176.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mercury Quant","PX-LH300797","CDM",83825,"CPT",300,"RC",{"$nulls":6},"both",null,null,126,126,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Norovirus Rna Amp Stool","PX-LH300807","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Head/Neck/Ptrunk","PX-LH4400300","CDM",300,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia,Surgery Intraperitoneal Upper Abdomen","PX-LH4400790","CDM",790,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Ldct for Lung Cancer Screen","PX-3520015","CDM",71271,"CPT",352,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Moblj Splenic Flxr Pfrmd Conjunct W/Prtl Colct","PX-44139","CDM",44139,"CPT",521,"RC",{"$nulls":6},"both",null,null,319.35,319.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},108.66,108.66,null,null,"facility"]
["Lh Anti-Mullerian Hormone","PX-LH300877","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Laps Surg Rpr Recurrent Inguinal Hernia","PX-49651","CDM",49651,"CPT",975,"RC",{"$nulls":6},"both",null,null,1552.44,1552.44,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},526.89,526.89,null,null,"facility"]
["HC Xray Chest 2 Views","PX-3240021","CDM",71046,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia Combined Upper & Lower Gastrointestinal Procedure","PX-LH4400813","CDM",813,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Amino Acid Analysis 2 to 5 Quant Ea Specmn","PX-LH300988","CDM",82136,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Occult Blood Fecal Globin Immuno","PX-LH301009","CDM",82274,"CPT",300,"RC",{"$nulls":6},"both",null,null,47.76,47.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Candida Species,Direct Probe","PX-LH301014","CDM",87480,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor Modulating Antibody","PX-LH301034","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Msh2 Gene Full Seq","PX-LH301041","CDM",81295,"CPT",300,"RC",{"$nulls":6},"both",null,null,1145.1,1145.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Cdsm Medcurrent","PX-3201002","CDM","G1002","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Allergen Specific Ige,Each","PX-LH301063","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Serum","PX-LH301091","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg I&R Only","PX-93018","CDM",93018,"CPT",521,"RC",{"$nulls":6},"both",null,null,39.66,39.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},13.27,13.27,null,null,"facility"]
["Hospital IP/Obs Discharge Day Mgmt > 30 Min","PX-99239","CDM",99239,"CPT",982,"RC",{"$nulls":6},"both",null,null,324.87,324.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},108.96,108.96,null,null,"facility"]
["Lh Lactoferrin Fecal (Quant)","PX-LH83631","CDM",83631,"CPT",300,"RC",{"$nulls":6},"both",null,null,157,157,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Assay of Estrone","PX-LH82679","CDM",82679,"CPT",300,"RC",{"$nulls":6},"both",null,null,176,176,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Apolipoprotein B","PX-LH82172","CDM",82172,"CPT",300,"RC",{"$nulls":6},"both",null,null,63.27,63.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Sterno-Clav Jts Min 3 V","PX-3200230","CDM",71130,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Xray Knees-Standing","PX-3200070","CDM",73565,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3310001","CDM",96402,"CPT",331,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500000","CDM",70490,"CPT",350,"RC",{"$nulls":6},"both",null,null,1420,1420,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC CT Spine Lumbar W/WO Dye","PX-3500013","CDM",72133,"CPT",350,"RC",{"$nulls":6},"both",null,null,1173.53,1173.53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520007","CDM",74150,"CPT",352,"RC",{"$nulls":6},"both",null,null,960,960,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["US Pelvic Limited","PX-4020025","CDM",76857,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Speech/Hearing Therapy","PX-4400001","CDM",92507,"CPT",440,"RC",{"$nulls":6},"both",null,null,223.14,223.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Treat Kneecap Dislocation","PX-4500037","CDM",27560,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Debride Infected Skin","PX-4560000","CDM",11000,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Skin Tags","PX-4900028","CDM",11200,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 1.1-2cm Remaindr Bod","PX-4900050","CDM",11422,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Trunk,Arm,Leg","PX-4900066","CDM",11601,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Extens","PX-4900094","CDM",11771,"CPT",360,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 7.6-12.5","PX-4900128","CDM",12044,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Foreign Body","PX-4900314","CDM",20520,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx","PX-4900574","CDM",25600,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Injection Hip Arthrogram","PX-4900722","CDM",27093,"CPT",360,"RC",{"$nulls":6},"both",null,null,620.23,620.23,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Revision of Foot Tendon","PX-4900908","CDM",28238,"CPT",360,"RC",{"$nulls":6},"both",null,null,20448.99,20448.99,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Remove Anal Tags","PX-4902148","CDM",46230,"CPT",360,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Removal of Testis Smpl","PX-4901466","CDM",54520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9964.74,9964.74,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm","PX-11307","CDM",11307,"CPT",521,"RC",{"$nulls":6},"both",null,null,401.37,401.37,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},58.68,134.32,null,null,"facility"]
["HC Intercostal Nerve Block,Mlt","PX-4901669","CDM",64421,"CPT",360,"RC",{"$nulls":6},"both",null,null,2670.87,2670.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Excis Chalazion,Single","PX-4901818","CDM",67800,"CPT",360,"RC",{"$nulls":6},"both",null,null,832.68,832.68,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",521,"RC",{"$nulls":6},"both",null,null,1272.33,1272.33,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},296,427.96,null,null,"facility"]
["HC Mileage","PX-5420001","CDM","A0425","HCPCS",542,"RC",{"$nulls":6},"both",null,null,27.06,27.06,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Upper Ext Joint W/WO Dye","PX-6100022","CDM",73223,"CPT",610,"RC",{"$nulls":6},"both",null,null,3680,3680,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["L-Spine","PX-6120008","CDM",72158,"CPT",612,"RC",{"$nulls":6},"both",null,null,2810,2810,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Icu Hourly Obs","PX-7620005","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,1387,1387,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Infusion","PX-9400008","CDM",96368,"CPT",260,"RC",{"$nulls":6},"both",null,null,612.66,612.66,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Diabetes Education","PX-9420005","CDM","G0109","HCPCS",942,"RC",{"$nulls":6},"both",null,null,45.69,45.69,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Repair Intermediate S/a/T/E 20.1-30.0 Cm","PX-12036","CDM",12036,"CPT",521,"RC",{"$nulls":6},"both",null,null,1228.5,1228.5,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},263.43,413.39,null,null,"facility"]
["Repair Complex Eyelid/Nose/Ear/Lip 2.6-7.5 Cm","PX-13152","CDM",13152,"CPT",521,"RC",{"$nulls":6},"both",null,null,1423.59,1423.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},316.35,477.45,null,null,"facility"]
["Injection Single Tendon Origin/Insertion","PX-20551","CDM",20551,"CPT",521,"RC",{"$nulls":6},"both",null,null,164.49,164.49,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},36.23,55.22,null,null,"facility"]
["Lh Hct","PX-LH300004","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Co 2","PX-LH300016","CDM",82374,"CPT",300,"RC",{"$nulls":6},"both",null,null,40,40,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T4 Total Ref","PX-LH300039","CDM",84436,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bld Type Rh","PX-LH300094","CDM",86901,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.25,39.25,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Aldosterone-Uri","PX-LH300126","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Coproporpyrins","PX-LH300151","CDM",84120,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.22,44.22,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Free T4 Ref","PX-LH300174","CDM",84439,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Influenza Ab A","PX-LH300203","CDM",86710,"CPT",300,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anaplasma Pcr Amp Ref","PX-LH300299","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pth Ref","PX-LH300336","CDM",83970,"CPT",300,"RC",{"$nulls":6},"both",null,null,319,319,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Transferrin","PX-LH300359","CDM",84466,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Mixing Study Ptt","PX-LH300381","CDM",85730,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Neut Cytoplasmi","PX-LH300415","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Hepatitis B Cor","PX-LH300437","CDM",86704,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisol Stimul","PX-LH300461","CDM",80400,"CPT",300,"RC",{"$nulls":6},"both",null,null,97.86,97.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Testosterone Fr","PX-LH300473","CDM",84402,"CPT",300,"RC",{"$nulls":6},"both",null,null,199,199,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Asca Iga, Igg Ref","PX-LH300497","CDM",86671,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Ebv,Capsid HB, Igm Ref.","PX-LH300533","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Typhus Antibody Ref","PX-LH300555","CDM",86000,"CPT",300,"RC",{"$nulls":6},"both",null,null,20.94,20.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Total Protien Ua, Random Ref Serum, Plasma, or Whole Blood","PX-LH300579","CDM",84155,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Bun Body Fluid Quant Ref","PX-LH300606","CDM",84520,"CPT",300,"RC",{"$nulls":6},"both",null,null,32,32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Antiphospholipid Panel Ref","PX-LH300637","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Nicotine(Cotinine) Ref","PX-LH300648","CDM",80323,"CPT",300,"RC",{"$nulls":6},"both",null,null,183,183,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anti-Hu Ab West Blot Ref","PX-LH300670","CDM",84181,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.09,51.09,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Alcohol Breath Dot","PX-LH300693","CDM",82075,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Pro-10(Chol/Ldl)","PX-LH300727","CDM",82465,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Peanut Ige Ref","PX-LH300753","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cortisol Free 24hr Ua Ref","PX-LH300775","CDM",82530,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.13,50.13,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh T-Cell Gene Study Beta Ref","PX-LH300786","CDM",81340,"CPT",300,"RC",{"$nulls":6},"both",null,null,626.76,626.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Cervical Collar-Stiffneck","PX-LH200519","CDM","LH200519","LOCAL",270,"RC",{"$nulls":6},"both",null,null,35.1,35.1,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Hourly Observation W/Monitor","PX-7621000","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,1118,1118,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Rom Test-Extremity/Trunk","PX-4200103","CDM",95851,"CPT",420,"RC",{"$nulls":6},"both",null,null,63.24,63.24,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Anesthesia T&A","PX-LH4400170","CDM",170,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Lh Physician E&M Visit,Trmt Room","PX-LH62212","CDM",99212,"CPT",761,"RC",{"$nulls":6},"both",null,null,70.86,70.86,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["Drain/Inject Joint/Bursa","PX-4902716","CDM",20606,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"facility"]
["HC Repair Ing Hernia,Slidin","PX-4902420","CDM",49525,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Glucose 6 Phosphate Quantitative","PX-LH300790","CDM",82955,"CPT",300,"RC",{"$nulls":6},"both",null,null,80,80,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Aspirate Pleura W/O Imaging","PX-4902461","CDM",32554,"CPT",360,"RC",{"$nulls":6},"both",null,null,1854.78,1854.78,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 2nd Level","PX-64494","CDM",64494,"CPT",521,"RC",{"$nulls":6},"both",null,null,2721.55,2721.55,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},47.86,87.81,null,null,"facility"]
["HC CT Tobacco Hx Chest","PX-3521000","CDM",71250,"CPT",352,"RC",{"$nulls":6},"both",null,null,1287,1287,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Fentanyl & Norfentanl,Urine","PX-LH300809","CDM",80354,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Colect W/Coloproctostomy","PX-4902528","CDM",44145,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Chemodenerv Musc Migraine","PX-4902655","CDM",64615,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Egd Transoral Biopsy Single/Multiple","PX-43239","CDM",43239,"CPT",521,"RC",{"$nulls":6},"both",null,null,2812.68,2812.68,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},129.51,364.61,null,null,"facility"]
["Lh Thc/Ratio Urine","PX-LH300874","CDM",80349,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Surg Tx Anal Fistula Subq","PX-46270","CDM",46270,"CPT",975,"RC",{"$nulls":6},"both",null,null,1522.05,1522.05,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},382.34,511.68,null,null,"facility"]
["Rpr Small Omphalocele W/Primary Closure","PX-49600","CDM",49600,"CPT",521,"RC",{"$nulls":6},"both",null,null,1999.11,1999.11,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},679.45,679.45,null,null,"facility"]
["Lh Anesthesia Lower Intestinal Endoscopic Procedure","PX-LH4400811","CDM",811,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Amino Acid Analysis,Plasma 6/> Quant Ea Specmn","PX-LH300992","CDM",82139,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.61,50.61,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Antiphospholipid Antibodies (Igg & Igm)","PX-LH300999","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Perq Replacement Gtube Req Revj Gstrst Trc","PX-43763","CDM",43763,"CPT",521,"RC",{"$nulls":6},"both",null,null,965.94,965.94,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},81.19,323.17,null,null,"facility"]
["Lh Hcv Quant Rt Pcr","PX-LH301020","CDM",87522,"CPT",300,"RC",{"$nulls":6},"both",null,null,332,332,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Destruct Neurolytic Agt Genicular Nrv W/Img","PX-4903352","CDM",64624,"CPT",360,"RC",{"$nulls":6},"both",null,null,5858.31,5858.31,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Cdsm Evicore","PX-3201001","CDM","G1001","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Trichomonas Vaginalis Rna, Amp Qual","PX-LH301053","CDM",87661,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Hepatitis a Ab, Total","PX-LH301073","CDM",86708,"CPT",300,"RC",{"$nulls":6},"both",null,null,98,98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen","PX-88142","CDM",88142,"CPT",521,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},20.26,20.26,null,null,"facility"]
["Lh Kappa/Lambda Light Chains, Free With Ratio","PX-LH83521","CDM",83521,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Hospital IP/Obs Care Same Date High Mdm 85 Min","PX-99236","CDM",99236,"CPT",982,"RC",{"$nulls":6},"both",null,null,587.64,587.64,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},197.3,197.3,null,null,"facility"]
["Lh Cytomegalovirus Amplified Probe Technique","PX-LH87496","CDM",87496,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Drug Test Def 1-7 Classes","PX-LH80339","CDM",80339,"CPT",300,"RC",{"$nulls":6},"both",null,null,98,98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Xr-Tmj","PX-3200011","CDM",70330,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Xr-Lumbar Spine","PX-3200025","CDM",72110,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Xray Knee","PX-3200067","CDM",73560,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["NM Muga Scan","PX-3410040","CDM",78473,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CT-Lumbar Spine","PX-3500012","CDM",72132,"CPT",350,"RC",{"$nulls":6},"both",null,null,1700,1700,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["CT Pelvis","PX-3520006","CDM",72194,"CPT",352,"RC",{"$nulls":6},"both",null,null,2270,2270,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["US Renal Complete","PX-4020009","CDM",76770,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Traction","PX-4200004","CDM",97012,"CPT",420,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Debridement","PX-4300025","CDM",97602,"CPT",430,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Apply Long Leg Cast","PX-4500051","CDM",29345,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Critical Care 1st Hour","PX-4500101","CDM",99291,"CPT",450,"RC",{"$nulls":6},"both",null,null,2057,2057,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Remove Foreign Body,Smpl","PX-4900007","CDM",10120,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Shav Skin Les 11-20mm Remaindr Body","PX-4900036","CDM",11307,"CPT",360,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Excision of Nail Fold, Toe","PX-4900092","CDM",11765,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Body 7.6-12.5","PX-4900112","CDM",12004,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Rep,Skin,Scalp/Extrem+5cm/<","PX-4900143","CDM",13122,"CPT",360,"RC",{"$nulls":6},"both",null,null,359.94,359.94,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Closed Rx Gr Tuberosity Hum Fx","PX-4900458","CDM",23620,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Amputation Finger/Thumb+Flaps","PX-4900712","CDM",26952,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Repair Exten Leg Tendon,Prim,Ea","PX-4900903","CDM",28208,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Cmplx","PX-4901081","CDM",30903,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Remove Tunnel Cv Access Device, W Port/Pump","PX-4901265","CDM",36590,"CPT",360,"RC",{"$nulls":6},"both",null,null,4577.79,4577.79,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Circumcision 28 Days or Older","PX-4901445","CDM",54161,"CPT",360,"RC",{"$nulls":6},"both",null,null,5821.98,5821.98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Intercostal Nerve Block,Sng","PX-4901668","CDM",64420,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Out of Room Procedure","PX-7620020","CDM",null,null,9999,"RC",{"$nulls":6},"both",null,null,3000,3000,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Glaucoma Surg,Trabecu Ab Externo","PX-4901766","CDM",66170,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 3.1-4.0cm","PX-11444","CDM",11444,"CPT",521,"RC",{"$nulls":6},"both",null,null,812.19,812.19,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},215.37,272.68,null,null,"facility"]
["Excision Malignant Lesion S/N/H/F/G 2.1-3.0 Cm","PX-11623","CDM",11623,"CPT",521,"RC",{"$nulls":6},"both",null,null,850.98,850.98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},198.33,285.42,null,null,"facility"]
["Excision Malignant Lesion F/E/E/N/L 3.1-4.0 Cm","PX-11644","CDM",11644,"CPT",521,"RC",{"$nulls":6},"both",null,null,1111.68,1111.68,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},265.57,373.3,null,null,"facility"]
["EEG","PX-7400003","CDM",95819,"CPT",740,"RC",{"$nulls":6},"both",null,null,934.2,934.2,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Immunization Administration","PX-7710000","CDM",90471,"CPT",771,"RC",{"$nulls":6},"both",null,null,213.51,213.51,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["HC Diabetes Train/Indiv 30 Min","PX-9420004","CDM","G0108","HCPCS",942,"RC",{"$nulls":6},"both",null,null,158.22,158.22,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Repair Intermediate S/a/T/E 12.6-20.0cm","PX-12035","CDM",12035,"CPT",521,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},227.1,373.47,null,null,"facility"]
["Repair Intermediate F/E/E/N/L&/Muc 5.1-7.5 Cm","PX-12053","CDM",12053,"CPT",521,"RC",{"$nulls":6},"both",null,null,1049.4,1049.4,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},204.55,351.57,null,null,"facility"]
["US Breast Unilateral Cmplt","PX-4020104","CDM",76641,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Injection Therapeutic Carpal Tunnel","PX-20526","CDM",20526,"CPT",521,"RC",{"$nulls":6},"both",null,null,233.31,233.31,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},52.98,78.52,null,null,"facility"]
["Lh Chloride Blood","PX-LH300015","CDM",82435,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Calcium Total","PX-LH300028","CDM",82310,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Culture Anaerobe Ref.","PX-LH300048","CDM",87075,"CPT",300,"RC",{"$nulls":6},"both",null,null,75,75,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Glucose Bld Excl Reag Strp WC/Lc","PX-LH300074","CDM",82947,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Alcohol Breath Ref","PX-LH300123","CDM",82075,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Endomysial Ab 1","PX-LH300161","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Hepatitis Panel, Acute","PX-LH300183","CDM",80074,"CPT",300,"RC",{"$nulls":6},"both",null,null,142.89,142.89,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh K Stool Ref","PX-LH300207","CDM",84999,"CPT",300,"RC",{"$nulls":6},"both",null,null,14.46,14.46,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Factor VII Ref","PX-LH300335","CDM",85230,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tissue Level 6","PX-LH300357","CDM",88309,"CPT",300,"RC",{"$nulls":6},"both",null,null,2457.87,2457.87,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Xylose Tolerance","PX-LH300369","CDM",84620,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.73,38.73,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Acid Phos Prost","PX-LH300391","CDM",84066,"CPT",300,"RC",{"$nulls":6},"both",null,null,28.98,28.98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Ebv Capsid Ag","PX-LH300413","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tobramycin Level Ref","PX-LH300447","CDM",80200,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.39,48.39,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Ca 19-9 Ref Tumor Antigen","PX-LH300460","CDM",86316,"CPT",300,"RC",{"$nulls":6},"both",null,null,158,158,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tsh Reflex Ref","PX-LH300482","CDM",84443,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Hba 1c","PX-LH300507","CDM",83036,"CPT",300,"RC",{"$nulls":6},"both",null,null,76,76,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Chlamydia Igm Ab Serum","PX-LH300530","CDM",86632,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.04,38.04,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Acth Plasma Ref","PX-LH300565","CDM",82024,"CPT",300,"RC",{"$nulls":6},"both",null,null,299,299,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Chlamydia Pneunoniae Igm Antibdy Ref","PX-LH300589","CDM",86632,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.04,38.04,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Anti Lkm-1 Ref","PX-LH300612","CDM",86376,"CPT",300,"RC",{"$nulls":6},"both",null,null,114,114,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Hepatitis E Igm Ref","PX-LH300647","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Parvovirus B19 Ab","PX-LH300669","CDM",86747,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.09,45.09,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Vitamin B 6 Ref","PX-LH300680","CDM",84207,"CPT",300,"RC",{"$nulls":6},"both",null,null,218,218,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Lysozyme Serum Ref","PX-LH300703","CDM",85549,"CPT",300,"RC",{"$nulls":6},"both",null,null,56.25,56.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Albumin Fluid Ref","PX-LH300725","CDM",82042,"CPT",300,"RC",{"$nulls":6},"both",null,null,23.34,23.34,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tissue Level 3 X2 Ref","PX-LH300763","CDM",88304,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Tissue Level 4 X 6 Ref","PX-LH300772","CDM",88305,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Arm Sling","PX-LH200160","CDM","LH200160","LOCAL",270,"RC",{"$nulls":6},"both",null,null,21,21,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Electrodes-Quick-Combo Clinic Lp 500","PX-LH200944","CDM","LH200944","LOCAL",270,"RC",{"$nulls":6},"both",null,null,116.25,116.25,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Thumb Spica Splint-Procare","PX-LH421859","CDM","L3999","HCPCS",270,"RC",{"$nulls":6},"both",null,null,31.98,31.98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Anesthesia Cystoscopy","PX-LH4400910","CDM",910,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Lh Diabetic Teaching 1 Pt 30 Min","PX-LH98960","CDM",98960,"CPT",942,"RC",{"$nulls":6},"both",null,null,158.22,158.22,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Clsd Tx Humeral Shaft Fracture W/O Manipulation","PX-24500","CDM",24500,"CPT",521,"RC",{"$nulls":6},"both",null,null,1076.01,1076.01,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":5},332.25,361.72,null,null,"facility"]
["Lh Trauma Activation Level I Assoc W/ Crit Care","PX-LHG0390L1","CDM","G0390","HCPCS",681,"RC",{"$nulls":6},"both",null,null,9000,9000,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":9},"facility"]
["Cltx Phlngl Fx Prox/Middle Px/F/T W/Manj Ea","PX-26725","CDM",26725,"CPT",521,"RC",{"$nulls":6},"both",null,null,1010.19,1010.19,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},301.14,339.78,null,null,"facility"]
["HC Ultrasound of Extremity","PX-4020077","CDM",76881,"CPT",402,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Shbg","PX-LH300791","CDM",84270,"CPT",300,"RC",{"$nulls":6},"both",null,null,171,171,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Cltx Trimalleolar Ankle Fx W/Manipulation","PX-27818","CDM",27818,"CPT",521,"RC",{"$nulls":6},"both",null,null,1432.92,1432.92,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},427.8,482.81,null,null,"facility"]
["HC Immunoperoxidase Stain","PX-401536078","CDM",88342,"CPT",312,"RC",{"$nulls":6},"both",null,null,514.08,514.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Application Cast Elbow Finger Short Arm","PX-29075","CDM",29075,"CPT",521,"RC",{"$nulls":6},"both",null,null,255.15,255.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},59.51,85.71,null,null,"facility"]
["Lh Hypersensitivity Pneumonitis Eval Igg","PX-LH300830","CDM",86609,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level","PX-64495","CDM",64495,"CPT",521,"RC",{"$nulls":6},"both",null,null,2966.52,2966.52,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},48.84,87.81,null,null,"facility"]
["Lh Mercury Quant","PX-LH300797","CDM",83825,"CPT",300,"RC",{"$nulls":6},"both",null,null,126,126,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Allergen Gluten Igg","PX-LH300842","CDM",86001,"CPT",300,"RC",{"$nulls":6},"both",null,null,54,54,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt L/S 2 Lev","PX-4903057","CDM",64494,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Strapping,Hand or Finger","PX-4200018","CDM",29280,"CPT",360,"RC",{"$nulls":6},"both",null,null,85.38,85.38,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Suture Sbd Dehiscence","PX-4902554","CDM",49900,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Chemodenervation Muscle Neck Unilat for Dystonia","PX-64616","CDM",64616,"CPT",521,"RC",{"$nulls":6},"both",null,null,380.04,380.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},100.16,128.97,null,null,"facility"]
["X-Ray Exam Entire Spine 2/3 Vw","PX-3200340","CDM",72082,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Mitochondria M2 Antibody Quantitative Nos","PX-LH300825","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["T-Cell Receptor (Tcr) Beta Gene","PX-LH300856","CDM",81340,"CPT",300,"RC",{"$nulls":6},"both",null,null,626.76,626.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Moblj Splenic Flxr Pfrmd Conjunct W/Prtl Colct","PX-44139","CDM",44139,"CPT",521,"RC",{"$nulls":6},"both",null,null,319.35,319.35,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},108.66,108.66,null,null,"facility"]
["Lh Von Willebrand Factor Antigen","PX-LH300867","CDM",85246,"CPT",300,"RC",{"$nulls":6},"both",null,null,68.82,68.82,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Ot Re-Eval Est Plan of Care","PX-4340014","CDM",97168,"CPT",434,"RC",{"$nulls":6},"both",null,null,204.48,204.48,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Colsc Flx With Directed Submucosal Njx Any Sbst","PX-45381","CDM",45381,"CPT",521,"RC",{"$nulls":6},"both",null,null,1275.84,1275.84,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},186.56,427.23,null,null,"facility"]
["HC Njx Interlaminar Crv/Thrc W/Img","PX-4902880","CDM",62321,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Laparoscopy Surg Rpr Initial Inguinal Hernia","PX-49650","CDM",49650,"CPT",975,"RC",{"$nulls":6},"both",null,null,1191.06,1191.06,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},404.14,404.14,null,null,"facility"]
["Lh Sex Hormone Binding Globulin (Shgb)","PX-LH300894","CDM",84270,"CPT",300,"RC",{"$nulls":6},"both",null,null,171,171,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Xray Chest 1 View","PX-3240020","CDM",71045,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Mammo of Both Breasts","PX-4030015","CDM",77067,"CPT",403,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Salm/Shig Culture Ref","PX-LH300975","CDM",87045,"CPT",300,"RC",{"$nulls":6},"both",null,null,75,75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Infliximab Level","PX-LH300983","CDM",80230,"CPT",300,"RC",{"$nulls":6},"both",null,null,115.71,115.71,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Fungal Smear Fluores/Af Stain","PX-LH301001","CDM",87206,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.17,16.17,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Incisional Bx Sngl Skin Lesion","PX-4903281","CDM",11106,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Culture,Mycobacterium (Afb)","PX-LH301012","CDM",87116,"CPT",300,"RC",{"$nulls":6},"both",null,null,32.4,32.4,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Trigeminal Nerve Each Branch","PX-64400","CDM",64400,"CPT",521,"RC",{"$nulls":6},"both",null,null,323.22,323.22,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},47.43,108.66,null,null,"facility"]
["Dstrj Neurolytic Agent Other Peripheral Nerve","PX-64640","CDM",64640,"CPT",521,"RC",{"$nulls":6},"both",null,null,720.06,720.06,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},113.25,240.95,null,null,"facility"]
["Lh Escherichia Coli 0157 Culture","PX-LH301021","CDM",87046,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Acetylcholine Receptor Modulating Antibody","PX-LH301034","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Pms2 Gene Full Seq","PX-LH301047","CDM",81317,"CPT",300,"RC",{"$nulls":6},"both",null,null,2029.5,2029.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Removal Impacted Cerumen Instrumentation Unilat","PX-69210","CDM",69210,"CPT",521,"RC",{"$nulls":6},"both",null,null,136.59,136.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},30.5,45.89,null,null,"facility"]
["HC Cdsm Qualified Nos","PX-3201011","CDM","G1011","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Hla A29 Birdshot Retinochoroidopathy","PX-LH301054","CDM",81374,"CPT",300,"RC",{"$nulls":6},"both",null,null,222.99,222.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Allergen Specific Ige,Each","PX-LH301063","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Coronavirus (Covid-19) Antigen","PX-LH301074","CDM",87426,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.99,105.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Pancreatic Elastase-1","PX-LH301087","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Bile Acids,Pregnancy","PX-LH301097","CDM",82542,"CPT",300,"RC",{"$nulls":6},"both",null,null,72.27,72.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Cv Strs Tst Xers&/or Rx Cont Ecg I&R Only","PX-93018","CDM",93018,"CPT",521,"RC",{"$nulls":6},"both",null,null,39.66,39.66,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},13.27,13.27,null,null,"facility"]
["Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj","PX-94010","CDM",94010,"CPT",521,"RC",{"$nulls":6},"both",null,null,79.35,79.35,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},7.7,26.53,null,null,"facility"]
["Lh Basic Metabolic Panel Calcium Ionized","PX-LH80047","CDM",80047,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.19,41.19,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Influeza a/B, Sars, Cov2, Rsv by Pcr","PX-LH87631","CDM",87631,"CPT",300,"RC",{"$nulls":6},"both",null,null,977,977,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Emergency Department Visit Moderate Mdm","PX-99284","CDM",99284,"CPT",521,"RC",{"$nulls":6},"both",null,null,335.04,335.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},112.97,112.97,null,null,"facility"]
["Lh Gip (Gastrointestinal Panel) 6-11 Targets","PX-LH87506","CDM",87506,"CPT",300,"RC",{"$nulls":6},"both",null,null,788.97,788.97,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Strep a Ag Ia","PX-LH87430","CDM",87430,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.43,50.43,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Asy Thiopurin S-Mthyltrnsfrs","PX-LH84433","CDM",84433,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Plasminogen Activator Inhibitor","PX-LH85415","CDM",85415,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.6,51.6,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Hla I Typing 1 Allele Hr","PX-LH81381","CDM",81381,"CPT",300,"RC",{"$nulls":6},"both",null,null,509.7,509.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Xr-Sinuses < 3 Views","PX-3200007","CDM",70210,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Lumbar Bending 4views","PX-3200027","CDM",72120,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Xray Humerus","PX-3200047","CDM",73060,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Xray Wrist","PX-3200054","CDM",73110,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Xr-Ribs 2 Views","PX-3240007","CDM",71100,"CPT",324,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NM Bone Scan","PX-3410026","CDM",78305,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["NM Perfusion Lung","PX-3410046","CDM",78580,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500000","CDM",70490,"CPT",350,"RC",{"$nulls":6},"both",null,null,1420,1420,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC CT Spine Lumbar W/WO Dye","PX-3500013","CDM",72133,"CPT",350,"RC",{"$nulls":6},"both",null,null,1173.53,1173.53,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["CT Thorax","PX-3520002","CDM",71270,"CPT",352,"RC",{"$nulls":6},"both",null,null,1778,1778,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Echo Exam of Head","PX-4020000","CDM",76506,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.25,319.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["US Renal Lmtd","PX-4020010","CDM",76775,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["US Pelvic Limited","PX-4020025","CDM",76857,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Unattend E-Stim","PX-4200005","CDM",97014,"CPT",420,"RC",{"$nulls":6},"both",null,null,33.78,33.78,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Work Hardening","PX-4300021","CDM",97545,"CPT",430,"RC",{"$nulls":6},"both",null,null,196.41,196.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Dev/Test-Limited","PX-4400011","CDM",96110,"CPT",918,"RC",{"$nulls":6},"both",null,null,148.99,148.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Closed Rx Clavicle Fracture","PX-4500013","CDM",23500,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Apply Long Leg Cast","PX-4500051","CDM",29345,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Insert Temp Bladder Catheter","PX-4500078","CDM",51702,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["ED Level I","PX-4500096","CDM",99281,"CPT",450,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Tte W/Doppler Complete","PX-4800009","CDM",93306,"CPT",483,"RC",{"$nulls":6},"both",null,null,1644.9,1644.9,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Remove Foreign Body,Smpl","PX-4900007","CDM",10120,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Shav Skin Les <5mm Face,Facial","PX-4900038","CDM",11310,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 0.6-1cm Remaindr Bod","PX-4900049","CDM",11421,"CPT",360,"RC",{"$nulls":6},"both",null,null,2110.77,2110.77,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 0.6-1cm Face,Facial","PX-4900055","CDM",11441,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Remaindr Bod","PX-4900072","CDM",11621,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Facial Nerve Block","PX-4900085","CDM",11730,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 2.6-5","PX-4900115","CDM",12013,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Rest Body 7.6-12.5","PX-4900128","CDM",12044,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Head,Fac,Hand 2.6-7.5","PX-4900145","CDM",13132,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Destruct Benign Lesion, 15+","PX-4900243","CDM",17111,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Biopsy Breast W/O Image","PX-4900269","CDM",19100,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Closed Rx Shldr Dislocation","PX-4900461","CDM",23650,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx","PX-4900574","CDM",25600,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Injection Hip Arthrogram","PX-4900722","CDM",27093,"CPT",360,"RC",{"$nulls":6},"both",null,null,620.23,620.23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Partial Removal of Ankle/Heel","PX-4900892","CDM",28120,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Correct Bunion,Othr Methods","PX-4900922","CDM",28299,"CPT",360,"RC",{"$nulls":6},"both",null,null,20448.99,20448.99,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Insert Emergency Airway","PX-4901106","CDM",31500,"CPT",360,"RC",{"$nulls":6},"both",null,null,696.66,696.66,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Remove Anal Tags","PX-4902148","CDM",46230,"CPT",360,"RC",{"$nulls":6},"both",null,null,8025.72,8025.72,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Declot Vascular Device","PX-4901268","CDM",36593,"CPT",360,"RC",{"$nulls":6},"both",null,null,968.04,968.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Cystourethroscopy","PX-4901365","CDM",52000,"CPT",360,"RC",{"$nulls":6},"both",null,null,1952.58,1952.58,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Paring/Cutting Benign Hyperkeratotic Lesion 1","PX-11055","CDM",11055,"CPT",521,"RC",{"$nulls":6},"both",null,null,208.41,208.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},14.59,69.6,null,null,"facility"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm","PX-11303","CDM",11303,"CPT",521,"RC",{"$nulls":6},"both",null,null,439.44,439.44,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},66.88,147.1,null,null,"facility"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm","PX-11306","CDM",11306,"CPT",521,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},46.06,119.08,null,null,"facility"]
["HC Intercostal Nerve Block,Sng","PX-4901668","CDM",64420,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC in Room Procedure","PX-7620021","CDM",null,null,9999,"RC",{"$nulls":6},"both",null,null,2250,2250,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Excis Pterygium,W Graft","PX-4901748","CDM",65426,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["HC Cataract Surg W Iol,1 Stage","PX-4901783","CDM",66984,"CPT",360,"RC",{"$nulls":6},"both",null,null,6661.05,6661.05,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Remove Ear Wax","PX-4901882","CDM",69210,"CPT",360,"RC",{"$nulls":6},"both",null,null,174.84,174.84,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm","PX-11604","CDM",11604,"CPT",521,"RC",{"$nulls":6},"both",null,null,892.98,892.98,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},201.28,299.52,null,null,"facility"]
["Excision Malignant Lesion S/N/H/F/G >4.0 Cm","PX-11626","CDM",11626,"CPT",521,"RC",{"$nulls":6},"both",null,null,1152.69,1152.69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},272.37,387.63,null,null,"facility"]
["Excision Malignant Lesion F/E/E/N/L 0.5 Cm/<","PX-11640","CDM",11640,"CPT",521,"RC",{"$nulls":6},"both",null,null,589.41,589.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},121.43,197.4,null,null,"facility"]
["Pelvis","PX-6100013","CDM",72195,"CPT",610,"RC",{"$nulls":6},"both",null,null,3070,3070,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["MRI-Brain/Brain Stem","PX-6110001","CDM",70551,"CPT",611,"RC",{"$nulls":6},"both",null,null,1590,1590,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["L-Spine","PX-6120008","CDM",72158,"CPT",612,"RC",{"$nulls":6},"both",null,null,2810,2810,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Upper GI Endoscopy,Biopsy","PX-7500001","CDM",43239,"CPT",750,"RC",{"$nulls":6},"both",null,null,2812.68,2812.68,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Upper GI","PX-7500006","CDM",43247,"CPT",750,"RC",{"$nulls":6},"both",null,null,2591.07,2591.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Wedge Excision Skin Nail Fold","PX-11765","CDM",11765,"CPT",521,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},90.1,162.14,null,null,"facility"]
["Duplex Upper Extremity","PX-9210018","CDM",93930,"CPT",921,"RC",{"$nulls":6},"both",null,null,700.41,700.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Infusion","PX-9400008","CDM",96368,"CPT",260,"RC",{"$nulls":6},"both",null,null,612.66,612.66,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Diabetes Education","PX-9420005","CDM","G0109","HCPCS",942,"RC",{"$nulls":6},"both",null,null,45.69,45.69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Tx Superficial Wound Dehiscence Simple Closure","PX-12020","CDM",12020,"CPT",521,"RC",{"$nulls":6},"both",null,null,1836.39,1836.39,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},178.69,289.04,null,null,"facility"]
["US Extremity","PX-4020075","CDM",76882,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Repair Complex Scalp/Arm/Leg Ea Addl 5 Cm/<","PX-13122","CDM",13122,"CPT",521,"RC",{"$nulls":6},"both",null,null,359.94,359.94,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},76.74,120.95,null,null,"facility"]
["Repair Complex Eyelid/Nose/Ear/Lip 2.6-7.5 Cm","PX-13152","CDM",13152,"CPT",521,"RC",{"$nulls":6},"both",null,null,1423.59,1423.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},316.35,477.45,null,null,"facility"]
["US Breast Unilateral Lmtd","PX-4020105","CDM",76642,"CPT",402,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Intubation/Aspiration","PX-4903219","CDM",43753,"CPT",360,"RC",{"$nulls":6},"both",null,null,897.18,897.18,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O US","PX-20610","CDM",20610,"CPT",521,"RC",{"$nulls":6},"both",null,null,885.57,885.57,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},42.48,62.12,null,null,"facility"]
["HC Swing Bed","PX-1200000","CDM",1200000,"LOCAL",120,"RC",{"$nulls":6},"both",null,null,5600,5600,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Hgb","PX-LH300003","CDM",85018,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Chloride Blood","PX-LH300015","CDM",82435,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Magnesium","PX-LH300032","CDM",83735,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Theophyline Ref","PX-LH300044","CDM",80198,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Culture Rectal Ref","PX-LH300055","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Culture Wound Ref","PX-LH300061","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Abo","PX-LH300093","CDM",86900,"CPT",300,"RC",{"$nulls":6},"both",null,null,128.9,128.9,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Aldosterone-Ser Ref","PX-LH300125","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anti-Dna Ref Native/Doubl","PX-LH300131","CDM",86225,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Ceruloplasin R","PX-LH300144","CDM",82390,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Estrogen Total Ref","PX-LH300163","CDM",82672,"CPT",300,"RC",{"$nulls":6},"both",null,null,65.1,65.1,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Free T4 Ref","PX-LH300174","CDM",84439,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Hepatitis Profile Acute","PX-LH300184","CDM",80074,"CPT",300,"RC",{"$nulls":6},"both",null,null,142.89,142.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Hiv-1 State Ref","PX-LH300191","CDM",86701,"CPT",300,"RC",{"$nulls":6},"both",null,null,26.67,26.67,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Influenza Ab A","PX-LH300203","CDM",86710,"CPT",300,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Methylmolonic A","PX-LH300214","CDM",83921,"CPT",300,"RC",{"$nulls":6},"both",null,null,135,135,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Anaplasma Pcr Amp Ref","PX-LH300299","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Pth Ref","PX-LH300336","CDM",83970,"CPT",300,"RC",{"$nulls":6},"both",null,null,319,319,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Rsv Culture Ref","PX-LH300341","CDM",87252,"CPT",300,"RC",{"$nulls":6},"both",null,null,78.21,78.21,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Tissue Level 1","PX-LH300352","CDM",88300,"CPT",300,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Antithrombin III Activity","PX-LH300376","CDM",85300,"CPT",300,"RC",{"$nulls":6},"both",null,null,93,93,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Mixing Study Ptt","PX-LH300381","CDM",85730,"CPT",300,"RC",{"$nulls":6},"both",null,null,47,47,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Fragile X Study","PX-LH300392","CDM",81243,"CPT",300,"RC",{"$nulls":6},"both",null,null,171.12,171.12,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Phosphate Urine","PX-LH300409","CDM",84105,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Vit D-Oh, D2, D3","PX-LH300420","CDM",82306,"CPT",300,"RC",{"$nulls":6},"both",null,null,228,228,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Kappa/Lambda Light Chain,Each","PX-LH300430","CDM",83520,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Rapid Strep","PX-LH300436","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Tobramycin Level Ref","PX-LH300447","CDM",80200,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.39,48.39,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Ca 19-9 Ref Tumor Antigen","PX-LH300460","CDM",86316,"CPT",300,"RC",{"$nulls":6},"both",null,null,158,158,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Anti-Phospholipid Panel Ref","PX-LH300478","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Activated Prot","PX-LH300490","CDM",85335,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.61,38.61,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Asca Iga, Igg Ref","PX-LH300497","CDM",86671,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Pro-2 Electrolyte Panel","PX-LH300509","CDM",80051,"CPT",300,"RC",{"$nulls":6},"both",null,null,21.03,21.03,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Pth Antibody Ref.","PX-LH300520","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Psa Cancer Screen","PX-LH300538","CDM","G0103","CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Group B Strep-Vag & Anal","PX-LH300549","CDM",87081,"CPT",300,"RC",{"$nulls":6},"both",null,null,19.89,19.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Glucose, Fluid Excl Blood Ref","PX-LH300567","CDM",82945,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Total Protien Ua, Random Ref Serum, Plasma, or Whole Blood","PX-LH300579","CDM",84155,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Ua Micro Walhalla","PX-LH300588","CDM",81015,"CPT",300,"RC",{"$nulls":6},"both",null,null,9.15,9.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Bnp","PX-LH300597","CDM",83880,"CPT",300,"RC",{"$nulls":6},"both",null,null,263,263,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Vitamin E Ref","PX-LH300608","CDM",84446,"CPT",300,"RC",{"$nulls":6},"both",null,null,111,111,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Benzodiazepine Panel Ref 1-12","PX-LH300619","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Antiphospholipid Panel Ref","PX-LH300637","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Nicotine(Cotinine) Ref","PX-LH300648","CDM",80323,"CPT",300,"RC",{"$nulls":6},"both",null,null,183,183,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Total Protein Electro CSF","PX-LH300653","CDM",84166,"CPT",300,"RC",{"$nulls":6},"both",null,null,144,144,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Vancomycin Peak Ref","PX-LH300664","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Allergy Test Eggs Ref","PX-LH300675","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Alcohol Breath Dot","PX-LH300693","CDM",82075,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Drug Screen 10 - Medicare","PX-LH300704","CDM","G0481","CPT",300,"RC",{"$nulls":6},"both",null,null,469.77,469.77,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Toxoplasma Antibodies Ref","PX-LH300715","CDM",86777,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.17,43.17,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Rast(Bermud. Grass) Ref","PX-LH300732","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Beta 2-Gly Pro Anti Ref","PX-LH300742","CDM",86146,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Strawberry Ige Ref","PX-LH300752","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Tissue Level 3 X2 Ref","PX-LH300763","CDM",88304,"CPT",300,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Bk Virus Pcr Quant. Ref","PX-LH300774","CDM",87799,"CPT",300,"RC",{"$nulls":6},"both",null,null,171.36,171.36,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Exam Level III Blood Draw & Ua","PX-LH301596","CDM","LH301596","LOCAL",300,"RC",{"$nulls":6},"both",null,null,123,123,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh RBC Antibody ID Ea Panel Ea Ser Techniq","PX-LH700009","CDM",86870,"CPT",300,"RC",{"$nulls":6},"both",null,null,488.22,488.22,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"facility"]
["Lh Cervical Collar-Stiffneck","PX-LH200519","CDM","LH200519","LOCAL",270,"RC",{"$nulls":6},"both",null,null,35.1,35.1,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Clsd Tx Shoulder Dislc W/Manipulation Req Anes","PX-23655","CDM",23655,"CPT",521,"RC",{"$nulls":6},"both",null,null,1178.85,1178.85,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},397.24,397.24,null,null,"facility"]
["Lh Shoe-Post OP","PX-LH201891","CDM","LH201891","LOCAL",270,"RC",{"$nulls":6},"both",null,null,23.22,23.22,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Arthroplasty Interphalangeal Jnt","PX-4902387","CDM",26535,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["HC Ekg-12 Leads-Ippe","PX-7300006","CDM","G0403","HCPCS",730,"RC",{"$nulls":6},"both",null,null,41.04,41.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Anesthesia Appendectomy","PX-LH4400840","CDM",840,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Anesthesia T&A","PX-LH4400170","CDM",170,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Continuous Glucose Monitoring Analysis I&R","PX-95251","CDM",95251,"CPT",521,"RC",{"$nulls":6},"both",null,null,98.76,98.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},33.09,33.09,null,null,"facility"]
["Lh RBC Leuko Reduc Unit 1","PX-LH300110","CDM","P9016","LOCAL",390,"RC",{"$nulls":6},"both",null,null,542.46,542.46,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Observation Admit/Disch Low Severity","PX-LH99234","CDM",99234,"CPT",762,"RC",{"$nulls":6},"both",null,null,197.97,197.97,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Lh Whirlpool Treatment","PX-LH460026","CDM",97022,"CPT",761,"RC",{"$nulls":6},"both",null,null,49.5,49.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Drain/Inject Joint/Bursa","PX-4902716","CDM",20606,"CPT",360,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"facility"]
["Cltx Metacarpophalangeal Dislc W/Manj W/O Anes","PX-26700","CDM",26700,"CPT",521,"RC",{"$nulls":6},"both",null,null,999.06,999.06,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},308.87,336.38,null,null,"facility"]
["Perq Drainage Pleura Insert Cath W/O Imaging","PX-32556","CDM",32556,"CPT",521,"RC",{"$nulls":6},"both",null,null,2148.48,2148.48,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},113.99,717.8,null,null,"facility"]
["Electrocardiogram,Complet Ippe","PX-G0403","CDM","G0403","CPT",521,"RC",{"$nulls":6},"both",null,null,41.04,41.04,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},13.76,13.76,null,null,"facility"]
["Application Long Leg Cast Thigh-Toe","PX-29345","CDM",29345,"CPT",521,"RC",{"$nulls":6},"both",null,null,389.91,389.91,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},93.47,131.12,null,null,"facility"]
["Lh Direct Antihuman Globulin,Each","PX-LH300802","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Inj Paravert F Jnt L/S 1 Lev","PX-4903056","CDM",64493,"CPT",360,"RC",{"$nulls":6},"both",null,null,2670.87,2670.87,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Tpmt Activity","PX-LH300816","CDM",82657,"CPT",300,"RC",{"$nulls":6},"both",null,null,66.51,66.51,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Nuc Mebrofenin","PX-3430031","CDM","A9537","HCPCS",343,"RC",{"$nulls":6},"both",null,null,218,218,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["T-Cell Receptor (Tcr) Beta Gene","PX-LH300856","CDM",81340,"CPT",300,"RC",{"$nulls":6},"both",null,null,626.76,626.76,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh West Nile Virus,Rna Amp","PX-LH300868","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Colonoscopy W/Biopsy Single/Multiple","PX-45380","CDM",45380,"CPT",975,"RC",{"$nulls":6},"both",null,null,3537.24,3537.24,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},186.89,418.39,null,null,"facility"]
["Lh Varicella-Zoster Virus Ab Acif","PX-LH300882","CDM",86787,"CPT",300,"RC",{"$nulls":6},"both",null,null,101,101,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Mammo of One Breast","PX-4010015","CDM",77065,"CPT",401,"RC",{"$nulls":6},"both",null,null,540,540,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Endoscopy Swallow Test","PX-4400030","CDM",92612,"CPT",440,"RC",{"$nulls":6},"both",null,null,581.82,581.82,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Hantavirus Antibody Igm","PX-LH301005","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Punch Biopsy Skin Single Lesion","PX-11104","CDM",11104,"CPT",521,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},43.93,121.54,null,null,"facility"]
["Injection Aa&/Strd Other Peripheral Nerve/Branch","PX-64450","CDM",64450,"CPT",964,"RC",{"$nulls":6},"both",null,null,2077.56,2077.56,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},39.51,72.58,null,null,"facility"]
["Lh Skeletal Muscle Relaxant 1-2","PX-LH301038","CDM",80369,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Rmvl FB Xtrnl Auditory Canal W/O Anes","PX-69200","CDM",69200,"CPT",521,"RC",{"$nulls":6},"both",null,null,231.06,231.06,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},44.76,77.5,null,null,"facility"]
["HC Nonmd Online Assmt 5-10 Min","PX-4200200","CDM","G2061","HCPCS",420,"RC",{"$nulls":6},"both",null,null,38.01,38.01,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Tricyclic & Cyclicals 6 or More","PX-LH301068","CDM",80337,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, (Medicare)","PX-LH301094","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Pressurized/Nonpressurized Inhalation Treatment","PX-94640","CDM",94640,"CPT",982,"RC",{"$nulls":6},"both",null,null,22.98,22.98,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},7.7,7.7,null,null,"facility"]
["Lh Group a Strep by Pcr","PX-LH87651","CDM",87651,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Clot Factor VIII Ahg 1 Stage","PX-LH85240","CDM",85240,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cytogenetics Interpretation","PX-LH88291","CDM",88291,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Orbits Min 4 Views","PX-3200006","CDM",70200,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Sacroiliac Joints","PX-3200031","CDM",72202,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Xray Wrist","PX-3200053","CDM",73100,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Dexascan","PX-3200218","CDM",77080,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CT-Cervical Spine","PX-3500007","CDM",72127,"CPT",352,"RC",{"$nulls":6},"both",null,null,1703,1703,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["CT-Thorax","PX-3520000","CDM",71250,"CPT",352,"RC",{"$nulls":6},"both",null,null,1287,1287,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["US Pregnancy Lmtd","PX-4020017","CDM",76815,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Iontophoresis 15 Min","PX-4300006","CDM",97033,"CPT",430,"RC",{"$nulls":6},"both",null,null,90,90,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Com/Work Re-Integra 15 Min","PX-4300019","CDM",97537,"CPT",430,"RC",{"$nulls":6},"both",null,null,92.7,92.7,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Closed Rx Elbow Dislocation","PX-4500021","CDM",24600,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Ipecac Administration","PX-4500095","CDM",99175,"CPT",450,"RC",{"$nulls":6},"both",null,null,154.25,154.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC I & D Pilonidal Cyst,Cmplx","PX-4900006","CDM",10081,"CPT",360,"RC",{"$nulls":6},"both",null,null,2110.77,2110.77,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Exc Skin Benig <5mm Face,Facial","PX-4900054","CDM",11440,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Exc Skin Malig >4cm Face,Facial","PX-4900082","CDM",11646,"CPT",360,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Trunk,Arm,Leg 2.6-7.5","PX-4900121","CDM",12032,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Face,Facial 2.5-5","PX-4900133","CDM",12052,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Chem Cautery Granulatn Tissue","PX-4900244","CDM",17250,"CPT",360,"RC",{"$nulls":6},"both",null,null,572.25,572.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Manipulate Finger With Anesth","PX-4900627","CDM",26340,"CPT",360,"RC",{"$nulls":6},"both",null,null,4593.99,4593.99,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Remove Heel Spur","PX-4900891","CDM",28119,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Drainage of Gum Lesion","PX-4902089","CDM",41800,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Rpr Init Femoral Hernia,Reduce","PX-4902267","CDM",49550,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Incision & Removal Foreign Body Subq Tiss Comp","PX-10121","CDM",10121,"CPT",521,"RC",{"$nulls":6},"both",null,null,758.64,758.64,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},174.42,254.65,null,null,"facility"]
["HC Insert Intrauterine Device","PX-4901562","CDM",58300,"CPT",360,"RC",{"$nulls":6},"both",null,null,1583.69,1583.69,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Destroy Nerve Face Muscle","PX-4901693","CDM",64612,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 3.1-4.0cm","PX-11424","CDM",11424,"CPT",521,"RC",{"$nulls":6},"both",null,null,682.86,682.86,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},172.93,229.25,null,null,"facility"]
["HC Allergen Immun;2 or More Injec","PX-5100023","CDM",95117,"CPT",510,"RC",{"$nulls":6},"both",null,null,135.78,135.78,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Chest WO/W Dye","PX-6100011","CDM",71552,"CPT",610,"RC",{"$nulls":6},"both",null,null,4920,4920,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["MRI-C-Spine","PX-6120000","CDM",72141,"CPT",612,"RC",{"$nulls":6},"both",null,null,1530,1530,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["EKG","PX-7300000","CDM",93005,"CPT",730,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Office Visit-Est Patient Level II","PX-7610006","CDM",99212,"CPT",510,"RC",{"$nulls":6},"both",null,null,377.85,377.85,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Port Flush","PX-9400017","CDM",96523,"CPT",761,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Simple Repair F/E/E/N/L/M 7.6cm-12.5 Cm","PX-12015","CDM",12015,"CPT",521,"RC",{"$nulls":6},"both",null,null,485.55,485.55,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},85.69,163.62,null,null,"facility"]
["Repair Complex Scalp/Arm/Leg 2.6-7.5 Cm","PX-13121","CDM",13121,"CPT",521,"RC",{"$nulls":6},"both",null,null,1836.39,1836.39,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},244.04,410.38,null,null,"facility"]
["Blepharoplasty Lower Eyelid","PX-15820","CDM",15820,"CPT",521,"RC",{"$nulls":6},"both",null,null,1683.42,1683.42,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},499.13,563.31,null,null,"facility"]
["Chemical Cauterization of Granulation Tissue","PX-17250","CDM",17250,"CPT",521,"RC",{"$nulls":6},"both",null,null,252.51,252.51,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},35.74,84.52,null,null,"facility"]
["HC Treat Finger Fracture,Each","PX-4902313","CDM",26740,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Gamma-Gt","PX-LH300031","CDM",82977,"CPT",300,"RC",{"$nulls":6},"both",null,null,58,58,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Culture Penis Ref","PX-LH300054","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cbc Auto W Auto Diff Wbc WC","PX-LH300070","CDM",85025,"CPT",300,"RC",{"$nulls":6},"both",null,null,56,56,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cea Ref","PX-LH300143","CDM",82378,"CPT",300,"RC",{"$nulls":6},"both",null,null,144,144,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Factor 13 Ref Clotting; Factor IX (Ptc or Christmas)","PX-LH300167","CDM",85250,"CPT",300,"RC",{"$nulls":6},"both",null,null,57.12,57.12,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Gentamicin","PX-LH300178","CDM",80170,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.14,49.14,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Immunofixation","PX-LH300202","CDM",86334,"CPT",300,"RC",{"$nulls":6},"both",null,null,174,174,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Osmolality Serum","PX-LH300224","CDM",83930,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Tissue Level 1","PX-LH300352","CDM",88300,"CPT",300,"RC",{"$nulls":6},"both",null,null,85.11,85.11,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Erythropoeitin","PX-LH300375","CDM",82668,"CPT",300,"RC",{"$nulls":6},"both",null,null,147,147,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Fragile X Study","PX-LH300392","CDM",81243,"CPT",300,"RC",{"$nulls":6},"both",null,null,171.12,171.12,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Citrate Urine R","PX-LH300407","CDM",82507,"CPT",300,"RC",{"$nulls":6},"both",null,null,216,216,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Immuno Elec UR","PX-LH300429","CDM",86335,"CPT",300,"RC",{"$nulls":6},"both",null,null,227,227,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Immunoglobulins","PX-LH300465","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cardiolipin Ab","PX-LH300489","CDM",86147,"CPT",300,"RC",{"$nulls":6},"both",null,null,164,164,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Blood Gases 2/> Analytes","PX-LH300502","CDM",82803,"CPT",300,"RC",{"$nulls":6},"both",null,null,137,137,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Thrombin Time Plasma","PX-LH300524","CDM",85670,"CPT",300,"RC",{"$nulls":6},"both",null,null,17.31,17.31,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Herpes Type 1 & 2 Igm Ref","PX-LH300571","CDM",86695,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.57,39.57,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Urovision Ref.","PX-LH300584","CDM",88271,"CPT",300,"RC",{"$nulls":6},"both",null,null,64.26,64.26,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Creatinine Body Fluid Ref","PX-LH300607","CDM",82570,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Vitamin B1 (Thiamine) Ref","PX-LH300630","CDM",84425,"CPT",300,"RC",{"$nulls":6},"both",null,null,157,157,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Vancomycin Peak Ref","PX-LH300664","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh T- Protein Fluid Ref","PX-LH300686","CDM",84157,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Gentamicin Peak Ref","PX-LH300702","CDM",80170,"CPT",300,"RC",{"$nulls":6},"both",null,null,49.14,49.14,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cardio Crp Ref","PX-LH300719","CDM",86141,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Uric Acid Crystals Oth Source Ref","PX-LH300743","CDM",84560,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Francisella Tularemia Ref","PX-LH300779","CDM",86000,"CPT",300,"RC",{"$nulls":6},"both",null,null,20.94,20.94,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Blood Typing, Rh (D)","PX-LH700008","CDM","LH700008","LOCAL",300,"RC",{"$nulls":6},"both",null,null,37,37,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Colles Splint","PX-LH201461","CDM","LH201461","LOCAL",270,"RC",{"$nulls":6},"both",null,null,13.23,13.23,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Cast - Full Arm - Fiberglass","PX-LH205040","CDM","LH205040","LOCAL",270,"RC",{"$nulls":6},"both",null,null,192.33,192.33,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Xr-Thoracic Spine 2 Views","PX-3200301","CDM",72070,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["HC Cardiac Rehab Phase III,Initial","PX-9430020","CDM",93797,"CPT",943,"RC",{"$nulls":6},"both",null,null,377.7,377.7,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Lh Non ER Procedures,Sig,Cysto,Stress","PX-LH99215","CDM",99215,"CPT",510,"RC",{"$nulls":6},"both",null,null,377.85,377.85,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"facility"]
["Treatment Closed Elbow Dislocation W/O Anes","PX-24600","CDM",24600,"CPT",521,"RC",{"$nulls":6},"both",null,null,1101.93,1101.93,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},334.66,371.33,null,null,"facility"]
["Cltx Post Hip Arthrp Dislc W/O Anes","PX-27265","CDM",27265,"CPT",521,"RC",{"$nulls":6},"both",null,null,1199.82,1199.82,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},404.85,404.85,null,null,"facility"]
["Removal Foreign Body Foot Subcutaneous","PX-28190","CDM",28190,"CPT",521,"RC",{"$nulls":6},"both",null,null,2110.77,2110.77,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},127.81,233.25,null,null,"facility"]
["HC Surgical Path-Level IV","PX-401536027","CDM",88305,"CPT",312,"RC",{"$nulls":6},"both",null,null,154.89,154.89,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Cocaine","PX-LH300833","CDM",80353,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Intubation Endotracheal Emergency Procedure","PX-31500","CDM",31500,"CPT",521,"RC",{"$nulls":6},"both",null,null,696.66,696.66,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},129.74,129.74,null,null,"facility"]
["Lh Uro Risk","PX-LH300811","CDM","LH300811","LOCAL",300,"RC",{"$nulls":6},"both",null,null,619,619,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Helicobacter Pylori Stool","PX-LH300848","CDM",87338,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Calprotectin Stool","PX-LH300849","CDM",83993,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Esophagoscopy Flexible Transoral Diagnostic","PX-43200","CDM",43200,"CPT",521,"RC",{"$nulls":6},"both",null,null,762.69,762.69,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},82.31,255.2,null,null,"facility"]
["Colectomy Prtl W/Coloproctostomy","PX-44145","CDM",44145,"CPT",975,"RC",{"$nulls":6},"both",null,null,4462.86,4462.86,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},1514.72,1514.72,null,null,"facility"]
["HC Ultrasound Exam Aaa Screen","PX-4020080","CDM",76706,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh West Nile Virus Ab,Igm","PX-LH300886","CDM",86788,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.55,50.55,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Cont Gluc Monitoring Patient Provided Equipment","PX-95249","CDM",95249,"CPT",521,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Chromosomal Microarray","PX-LH300987","CDM",81229,"CPT",300,"RC",{"$nulls":6},"both",null,null,3480,3480,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Tangential Biopsy Skin Ea Sep/Additional Lesion","PX-11103","CDM",11103,"CPT",521,"RC",{"$nulls":6},"both",null,null,145.89,145.89,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},20.65,48.81,null,null,"facility"]
["Diagnostic Lumbar Spinal Puncture","PX-62270","CDM",62270,"CPT",964,"RC",{"$nulls":6},"both",null,null,414.84,414.84,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},57.94,139.48,null,null,"facility"]
["Lh Candida Species,Direct Probe","PX-LH301014","CDM",87480,"CPT",300,"RC",{"$nulls":6},"both",null,null,60.15,60.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Posaconazole","PX-LH301032","CDM",80187,"CPT",300,"RC",{"$nulls":6},"both",null,null,81.33,81.33,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Cdsm Aim","PX-3201007","CDM","G1007","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Bile Acids,Total","PX-LH301066","CDM",82239,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.36,51.36,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Mycophenolic Acid","PX-LH301086","CDM",80180,"CPT",300,"RC",{"$nulls":6},"both",null,null,123,123,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Urine","PX-LH301093","CDM",80346,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn","PX-94060","CDM",94060,"CPT",521,"RC",{"$nulls":6},"both",null,null,113.73,113.73,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},9.67,37.99,null,null,"facility"]
["Emergency Department Visit Straightforward Mdm","PX-99282","CDM",99282,"CPT",521,"RC",{"$nulls":6},"both",null,null,115.74,115.74,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},39.02,39.02,null,null,"facility"]
["Lh T Cells Total Count","PX-LH86359","CDM",86539,"CPT",300,"RC",{"$nulls":6},"both",null,null,37.98,37.98,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Lacosamide Serum or Plasma","PX-LH80235","CDM",80235,"CPT",301,"RC",{"$nulls":6},"both",null,null,115,115,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Xr-Spine 4/5 Views","PX-3200017","CDM",72050,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Xray Forearm","PX-3200051","CDM",73090,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Xray Finger","PX-3200058","CDM",73140,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Chemo Administration","PX-3350003","CDM",96415,"CPT",335,"RC",{"$nulls":6},"both",null,null,201.36,201.36,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500002","CDM",70492,"CPT",350,"RC",{"$nulls":6},"both",null,null,2070,2070,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["CT-Thorax","PX-3520010","CDM",71260,"CPT",352,"RC",{"$nulls":6},"both",null,null,1890,1890,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC US Guidance/Ndl Placement","PX-4020035","CDM",76942,"CPT",402,"RC",{"$nulls":6},"both",null,null,393.36,393.36,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Self-Care/Hm Mgmt Tx 15min","PX-4300018","CDM",97535,"CPT",430,"RC",{"$nulls":6},"both",null,null,95.67,95.67,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Dysphagia Study","PX-4400003","CDM",92526,"CPT",440,"RC",{"$nulls":6},"both",null,null,247.68,247.68,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Closed Rx Mt-Phal Toe Dislocation","PX-4500041","CDM",28630,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Pre/Post Spiro","PX-4600002","CDM",94060,"CPT",460,"RC",{"$nulls":6},"both",null,null,897.18,897.18,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Shav Skin Les <5mm Trunk,Arm,Leg","PX-4900030","CDM",11300,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Exc Skin Benig 3.1-4cm Remaindr Bod","PX-4900052","CDM",11424,"CPT",360,"RC",{"$nulls":6},"both",null,null,4634.25,4634.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 2.1-3cm Trunk,Arm,Leg","PX-4900068","CDM",11603,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Facial<2.5cm","PX-4900132","CDM",12051,"CPT",360,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Layr Clos Wnd Face,Facial 7.6-12.5","PX-4900135","CDM",12054,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Inj Trigger Point,1 or 2","PX-4900319","CDM",20552,"CPT",360,"RC",{"$nulls":6},"both",null,null,885.57,885.57,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Closed Rx Navicular Fx","PX-4900580","CDM",25622,"CPT",360,"RC",{"$nulls":6},"both",null,null,719.64,719.64,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Repair Hallux Rigidus","PX-4900915","CDM",28289,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Remove Pharynx Foreign Body","PX-4902166","CDM",42809,"CPT",360,"RC",{"$nulls":6},"both",null,null,1138.89,1138.89,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Change of Bladder Tube Smpl","PX-4901351","CDM",51705,"CPT",360,"RC",{"$nulls":6},"both",null,null,729.63,729.63,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Remove Hydrocele","PX-4901481","CDM",55040,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Spinal Puncture,Therapeutic","PX-4901629","CDM",62272,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm","PX-11401","CDM",11401,"CPT",521,"RC",{"$nulls":6},"both",null,null,452.97,452.97,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},101.92,151.69,null,null,"facility"]
["HC Fix Lid Ptosis,Levatr Resec,Intern","PX-4901831","CDM",67903,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Laryngeal Function Study","PX-5100017","CDM",92520,"CPT",510,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Bls,ER","PX-5420003","CDM","A0429","HCPCS",542,"RC",{"$nulls":6},"both",null,null,1346.94,1346.94,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["MRI Lower Extremity","PX-6100026","CDM",73720,"CPT",610,"RC",{"$nulls":6},"both",null,null,4200,4200,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["EKG","PX-7300000","CDM",93005,"CPT",730,"RC",{"$nulls":6},"both",null,null,178.2,178.2,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Excision Pilonidal Cyst/Sinus Complicated","PX-11772","CDM",11772,"CPT",521,"RC",{"$nulls":6},"both",null,null,2185.11,2185.11,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},547.1,735.7,null,null,"facility"]
["IV Push","PX-9400011","CDM",96374,"CPT",260,"RC",{"$nulls":6},"both",null,null,632.07,632.07,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.6-7.5 Cm","PX-12042","CDM",12042,"CPT",521,"RC",{"$nulls":6},"both",null,null,1198.59,1198.59,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},186.66,300.28,null,null,"facility"]
["Adjt Tis Trns/Reargmt F/C/C/M/N/a/G/H/F 10sqcm/<","PX-14040","CDM",14040,"CPT",521,"RC",{"$nulls":6},"both",null,null,5212.59,5212.59,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},595.59,732.78,null,null,"facility"]
["Destruction Benign Lesions 15/>","PX-17111","CDM",17111,"CPT",521,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},80.61,129.72,null,null,"facility"]
["Injection Single/Mlt Trigger Point 3/> Muscles","PX-20553","CDM",20553,"CPT",521,"RC",{"$nulls":6},"both",null,null,885.57,885.57,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},39.51,58.17,null,null,"facility"]
["Lh Esr Auto","PX-LH300006","CDM",85652,"CPT",300,"RC",{"$nulls":6},"both",null,null,21,21,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh CK (Crea Kinase) Total","PX-LH300029","CDM",82550,"CPT",300,"RC",{"$nulls":6},"both",null,null,50,50,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Bcan","PX-LH300066","CDM",87040,"CPT",300,"RC",{"$nulls":6},"both",null,null,81,81,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Coombs (Dat) Ref","PX-LH300096","CDM",86880,"CPT",300,"RC",{"$nulls":6},"both",null,null,45,45,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh a-Feto-Protein Serum Ref","PX-LH300128","CDM",82105,"CPT",300,"RC",{"$nulls":6},"both",null,null,130,130,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh D-Dimer Quant","PX-LH300158","CDM",85379,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Fsh Ref","PX-LH300175","CDM",83001,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Lithium Ref","PX-LH300211","CDM",80178,"CPT",300,"RC",{"$nulls":6},"both",null,null,52,52,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Antigranulocyte Ab Ref","PX-LH300301","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Vancomycin Ref","PX-LH300362","CDM",80202,"CPT",300,"RC",{"$nulls":6},"both",null,null,105,105,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Ena","PX-LH300384","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Acetaminophen","PX-LH300406","CDM",80299,"CPT",300,"RC",{"$nulls":6},"both",null,null,107,107,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Iga Ref","PX-LH300417","CDM",82784,"CPT",300,"RC",{"$nulls":6},"both",null,null,73,73,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Rapid Strep WC","PX-LH300439","CDM",87301,"CPT",300,"RC",{"$nulls":6},"both",null,null,35.94,35.94,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Gliadin Ab, Igg","PX-LH300463","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Celiac Sprue Re","PX-LH300501","CDM",86255,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Culture, Other Aerob.","PX-LH300523","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Rnp Antibody Ref.","PX-LH300535","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Salmonella Total Ab Ref","PX-LH300559","CDM",86768,"CPT",300,"RC",{"$nulls":6},"both",null,null,39.57,39.57,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Creatinine Ua, Random Ref","PX-LH300580","CDM",82570,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Cyclic Citrillinated Peptide Ref","PX-LH300616","CDM",86200,"CPT",300,"RC",{"$nulls":6},"both",null,null,102,102,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Rsv Swab","PX-LH300639","CDM",87807,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Alpha 1-Antitryspin Pheno Serum","PX-LH300661","CDM",82104,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.38,43.38,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Protime Inr WC","PX-LH300696","CDM",85610,"CPT",300,"RC",{"$nulls":6},"both",null,null,29,29,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Mygolobin Serum Ref","PX-LH300718","CDM",83874,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.76,38.76,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Pro-12(Trig/Ldl)","PX-LH300729","CDM",84478,"CPT",300,"RC",{"$nulls":6},"both",null,null,46,46,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh TB Gold Ref","PX-LH300755","CDM",86480,"CPT",300,"RC",{"$nulls":6},"both",null,null,504,504,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh C-Diff Dna-Pcr Ref","PX-LH300777","CDM",87493,"CPT",300,"RC",{"$nulls":6},"both",null,null,269,269,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Cltx Prox Humrl Fx W/Mnpj W/WO Skeletal Tracj","PX-23605","CDM",23605,"CPT",521,"RC",{"$nulls":6},"both",null,null,1372.41,1372.41,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},417.58,462.11,null,null,"facility"]
["Lh Sams Splint 4 1/2 X 36 Orange/Blue","PX-LH202611","CDM","LH202611","LOCAL",270,"RC",{"$nulls":6},"both",null,null,32.64,32.64,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC Peritoneal Dialysis OP/Obs","PX-8300000","CDM",90945,"CPT",830,"RC",{"$nulls":6},"both",null,null,1266,1266,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Anesthesia Lesion Rml Soft Tissue Bx Face","PX-LH4400164","CDM",164,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Lh Anesthesia Iridectomy","PX-LH4400147","CDM",147,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["HC C-Pap","PX-4100019","CDM",94660,"CPT",410,"RC",{"$nulls":6},"both",null,null,610.17,610.17,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"facility"]
["Closed Tx Radial&Ulnar Shaft Fractures W/O Mnpj","PX-25560","CDM",25560,"CPT",521,"RC",{"$nulls":6},"both",null,null,719.64,719.64,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},258.8,290.89,null,null,"facility"]
["HC Ultrasound of Extremity","PX-4020077","CDM",76881,"CPT",402,"RC",{"$nulls":6},"both",null,null,314.25,314.25,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Thyroid Imaging","PX-3410086","CDM",78014,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh PCP","PX-LH300832","CDM",83992,"CPT",300,"RC",{"$nulls":6},"both",null,null,176.09,176.09,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Myocardial Spect Multiple Studies","PX-78452","CDM",78452,"CPT",960,"RC",{"$nulls":6},"both",null,null,3916.44,3916.44,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},72.07,72.07,null,null,"facility"]
["Port&Line Draw","PX-LH300838","CDM",36591,"CPT",300,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Anesthesia Repair of Hernia V&a Lwr Abd","PX-LH4400832","CDM",832,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Exc Lesion Tongue W/Clsr Anterior Two-Thirds","PX-41112","CDM",41112,"CPT",521,"RC",{"$nulls":6},"both",null,null,981.09,981.09,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},234.32,328.62,null,null,"facility"]
["Calprotectin,Stool","PX-LH300852","CDM",83993,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",521,"RC",{"$nulls":6},"both",null,null,654,654,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},220.52,220.52,null,null,"facility"]
["Lh Thc/Ratio Urine","PX-LH300874","CDM",80349,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Anoscopy Dx W/Collj Spec Br/Wa Spx When Prfrmd","PX-46600","CDM",46600,"CPT",975,"RC",{"$nulls":6},"both",null,null,342.27,342.27,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},39.18,114.49,null,null,"facility"]
["Lh Olanzapine (Zypresa)","PX-LH300896","CDM",80342,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Anesthesia Combined Upper & Lower Gastrointestinal Procedure","PX-LH4400813","CDM",813,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Amino Acid Analysis 2 to 5 Quant Ea Specmn","PX-LH300988","CDM",82136,"CPT",300,"RC",{"$nulls":6},"both",null,null,131,131,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Fungal Smear Fluores/Af Stain","PX-LH301001","CDM",87206,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.17,16.17,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Chemodnrvtj Musc Musc Innervated Facial Nrv Unil","PX-64612","CDM",64612,"CPT",521,"RC",{"$nulls":6},"both",null,null,390.45,390.45,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},113.13,131.47,null,null,"facility"]
["Removal FB Eye Conjunctival Superficial","PX-65205","CDM",65205,"CPT",981,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},27.36,27.69,null,null,"facility"]
["Lh Msh2 Gene Dup.Delete Variant","PX-LH301042","CDM",81297,"CPT",300,"RC",{"$nulls":6},"both",null,null,639.9,639.9,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Cdsm Medicalis","PX-3201003","CDM","G1003","HCPCS",329,"RC",{"$nulls":6},"both",null,null,0.01,0.01,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Pregablin,Urine,Quant,Medicare","PX-LH301076","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,430.29,430.29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Flunitrazepam, Quant, Serum (Medicare)","PX-LH301092","CDM","G0480","HCPCS",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj","PX-94010","CDM",94010,"CPT",521,"RC",{"$nulls":6},"both",null,null,79.35,79.35,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},7.7,26.53,null,null,"facility"]
["Lh Infectious Disease (Viral Respiratory Tract Infection), Pathogen-Specific Rna, 4 Targets","PX-LH0241U","CDM","0241U","CPT",310,"RC",{"$nulls":6},"both",null,null,427.89,427.89,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Hospital IP/Obs Discharge Day Mgmt 30 Min/<","PX-99238","CDM",99238,"CPT",982,"RC",{"$nulls":6},"both",null,null,230.07,230.07,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},77.17,77.17,null,null,"facility"]
["Lh Resp Syncytial Virus Ag Ia","PX-LH87420","CDM",87420,"CPT",300,"RC",{"$nulls":6},"both",null,null,41.73,41.73,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Apolipoprotein B","PX-LH82172","CDM",82172,"CPT",300,"RC",{"$nulls":6},"both",null,null,63.27,63.27,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Sterno-Clav Jts Min 3 V","PX-3200230","CDM",71130,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Lumbar Bending 4views","PX-3200027","CDM",72120,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Xray Knee","PX-3200069","CDM",73564,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["NM Brain Flow Image","PX-3410052","CDM",78610,"CPT",341,"RC",{"$nulls":6},"both",null,null,1614.81,1614.81,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CT Upper Extremity","PX-3500016","CDM",73200,"CPT",350,"RC",{"$nulls":6},"both",null,null,1380,1380,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["CT Abdomen","PX-3520008","CDM",74160,"CPT",352,"RC",{"$nulls":6},"both",null,null,1204.65,1204.65,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Ortho Mgt/Training Initial","PX-4200012","CDM",97760,"CPT",420,"RC",{"$nulls":6},"both",null,null,139.86,139.86,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Speech/Hearing Therapy Group","PX-4400002","CDM",92508,"CPT",440,"RC",{"$nulls":6},"both",null,null,71.1,71.1,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Fibula Fx","PX-4500105","CDM",27786,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Apply Long Arm Splint","PX-4500045","CDM",29105,"CPT",360,"RC",{"$nulls":6},"both",null,null,473.37,473.37,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Wound Clos/Tissue Adhesiv Only","PX-4500102","CDM","G0168","HCPCS",490,"RC",{"$nulls":6},"both",null,null,355.89,355.89,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Shav Skin Les 6-10mm Face,Facial","PX-4900039","CDM",11311,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Exc Skin Malig 0.6-1cm Trunk,Arm,Leg","PX-4900066","CDM",11601,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Remv Pilonidal Lesion Extens","PX-4900094","CDM",11771,"CPT",360,"RC",{"$nulls":6},"both",null,null,8122.05,8122.05,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face 2.6-5","PX-4900115","CDM",12013,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Head,Fac,Hand 2.6-7.5","PX-4900145","CDM",13132,"CPT",360,"RC",{"$nulls":6},"both",null,null,1795.2,1795.2,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Inj Tendon Sheath/Ligament","PX-4900317","CDM",20550,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Injection Sacroiliac Joint","PX-4900724","CDM",27096,"CPT",360,"RC",{"$nulls":6},"both",null,null,411,411,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Repair of Hammertoe","PX-4900913","CDM",28285,"CPT",360,"RC",{"$nulls":6},"both",null,null,9252.09,9252.09,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Rpr Inguinal Hernia,Reduce","PX-4902265","CDM",49520,"CPT",360,"RC",{"$nulls":6},"both",null,null,9889.02,9889.02,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Debridement Muscle &/Fascia 1st 20 Sq Cm/<","PX-11043","CDM",11043,"CPT",521,"RC",{"$nulls":6},"both",null,null,662.37,662.37,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},143.64,222.56,null,null,"facility"]
["Spinal Puncture","PX-4901628","CDM",62270,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Destroy Nerve Face Muscle","PX-4901693","CDM",64612,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Remove FB-Eye","PX-4901735","CDM",65205,"CPT",360,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Incise Eardrum,Aspir,Gen Anesth","PX-4901890","CDM",69421,"CPT",360,"RC",{"$nulls":6},"both",null,null,9202.86,9202.86,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Mileage","PX-5420001","CDM","A0425","HCPCS",542,"RC",{"$nulls":6},"both",null,null,27.06,27.06,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Upper Ext Joint W/WO Dye","PX-6100022","CDM",73223,"CPT",610,"RC",{"$nulls":6},"both",null,null,3680,3680,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["MRI-Brain/Brain Stem","PX-6110001","CDM",70551,"CPT",611,"RC",{"$nulls":6},"both",null,null,1590,1590,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Upper GI Endoscopy,Dx","PX-7500000","CDM",43235,"CPT",750,"RC",{"$nulls":6},"both",null,null,2812.68,2812.68,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Gastric Intubat Dx W/Aspiration Single Specimen","PX-43754","CDM",43754,"CPT",521,"RC",{"$nulls":6},"both",null,null,684.51,684.51,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},35.75,228.61,null,null,"facility"]
["Cardiac Rehab/Phase I Non-Monitored","PX-9430000","CDM",93797,"CPT",943,"RC",{"$nulls":6},"both",null,null,377.7,377.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Repair Intermediate S/a/T/E >30.0 Cm","PX-12037","CDM",12037,"CPT",521,"RC",{"$nulls":6},"both",null,null,1375.74,1375.74,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},305.44,463.27,null,null,"facility"]
["Blepharoplasty Lower Eyelid","PX-15820","CDM",15820,"CPT",521,"RC",{"$nulls":6},"both",null,null,1683.42,1683.42,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},499.13,563.31,null,null,"facility"]
["Injection Single/Mlt Trigger Point 1/2 Muscles","PX-20552","CDM",20552,"CPT",521,"RC",{"$nulls":6},"both",null,null,885.57,885.57,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":5},34.75,50.47,null,null,"facility"]
["Lh Platelets Auto","PX-LH300005","CDM",85049,"CPT",300,"RC",{"$nulls":6},"both",null,null,35,35,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh CK (Crea Kinase) Total","PX-LH300029","CDM",82550,"CPT",300,"RC",{"$nulls":6},"both",null,null,50,50,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh T4 Total Ref","PX-LH300039","CDM",84436,"CPT",300,"RC",{"$nulls":6},"both",null,null,53,53,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Mono","PX-LH300077","CDM",86308,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Aldosterone-Uri","PX-LH300126","CDM",82088,"CPT",300,"RC",{"$nulls":6},"both",null,null,315,315,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Coproporpyrins","PX-LH300151","CDM",84120,"CPT",300,"RC",{"$nulls":6},"both",null,null,44.22,44.22,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Estrogen Total Ref","PX-LH300163","CDM",82672,"CPT",300,"RC",{"$nulls":6},"both",null,null,65.1,65.1,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Hepatitis C Profile Rna","PX-LH300186","CDM",87522,"CPT",300,"RC",{"$nulls":6},"both",null,null,332,332,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Lh Ref","PX-LH300209","CDM",83002,"CPT",300,"RC",{"$nulls":6},"both",null,null,145,145,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Quinidin Ref","PX-LH300337","CDM",80194,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.8,43.8,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Uric Acid 24 UR","PX-LH300360","CDM",84560,"CPT",300,"RC",{"$nulls":6},"both",null,null,38,38,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Parasite ID Re","PX-LH300371","CDM",87999,"CPT",300,"RC",{"$nulls":6},"both",null,null,218.8,218.8,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Hiv 1/Hiv-2 Ei","PX-LH300416","CDM",87389,"CPT",300,"RC",{"$nulls":6},"both",null,null,162,162,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Hepatitis B Sur","PX-LH300438","CDM",86706,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Cortisol Stimul","PX-LH300461","CDM",80400,"CPT",300,"RC",{"$nulls":6},"both",null,null,97.86,97.86,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Testosterone Fr","PX-LH300473","CDM",84402,"CPT",300,"RC",{"$nulls":6},"both",null,null,199,199,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Asca Iga, Igg Ref","PX-LH300497","CDM",86671,"CPT",300,"RC",{"$nulls":6},"both",null,null,36.75,36.75,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Ebv,Capsid HB, Igm Ref.","PX-LH300533","CDM",86665,"CPT",300,"RC",{"$nulls":6},"both",null,null,54.42,54.42,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Typhus Antibody Ref","PX-LH300555","CDM",86000,"CPT",300,"RC",{"$nulls":6},"both",null,null,20.94,20.94,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Glucose, Fluid Excl Blood Ref","PX-LH300567","CDM",82945,"CPT",300,"RC",{"$nulls":6},"both",null,null,31,31,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Ttg-Iga,Igg Ref","PX-LH300592","CDM",83516,"CPT",300,"RC",{"$nulls":6},"both",null,null,92,92,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Carbamazepine Free Reff","PX-LH300614","CDM",80156,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.71,43.71,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Cmv Quant Ref","PX-LH300649","CDM",87497,"CPT",300,"RC",{"$nulls":6},"both",null,null,343,343,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Pm-Sci Antibodies Ref","PX-LH300671","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Factor X (10) Ref","PX-LH300682","CDM",85260,"CPT",300,"RC",{"$nulls":6},"both",null,null,53.7,53.7,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Myeloperoxidase Ab Ref","PX-LH300705","CDM",86021,"CPT",300,"RC",{"$nulls":6},"both",null,null,45.15,45.15,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Orange Ige Ref","PX-LH300754","CDM",86003,"CPT",300,"RC",{"$nulls":6},"both",null,null,34,34,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Prot/Creat Ua Ratio","PX-LH300773","CDM",82570,"CPT",300,"RC",{"$nulls":6},"both",null,null,41,41,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh T-Cell Gene Study Beta Ref","PX-LH300786","CDM",81340,"CPT",300,"RC",{"$nulls":6},"both",null,null,626.76,626.76,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Cervical Collar-Stiffneck","PX-LH200519","CDM","LH200519","LOCAL",270,"RC",{"$nulls":6},"both",null,null,35.1,35.1,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Hourly Observation W/Monitor","PX-7621000","CDM","G0378","HCPCS",762,"RC",{"$nulls":6},"both",null,null,1118,1118,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Rom Test-Extremity/Trunk","PX-4200103","CDM",95851,"CPT",420,"RC",{"$nulls":6},"both",null,null,63.24,63.24,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Anesthesia Hernia Rpr Upper Abd","PX-LH4400750","CDM",750,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Diabetic Teaching 5-8 Pts 30 Min","PX-LH98962","CDM",98962,"CPT",942,"RC",{"$nulls":6},"both",null,null,45.69,45.69,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["Lh Pneumoccal Ppsv23 Vaccine 2/> Yo","PX-LH422425","CDM",90732,"CPT",636,"RC",{"$nulls":6},"both",null,null,400.41,400.41,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":9},"facility"]
["HC Surgical Path-Level V","PX-401536047","CDM",88307,"CPT",312,"RC",{"$nulls":6},"both",null,null,1027.44,1027.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Closed Tx Knee Dislocation W/Anesthesia","PX-27552","CDM",27552,"CPT",521,"RC",{"$nulls":6},"both",null,null,1805.31,1805.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},609.15,609.15,null,null,"facility"]
["HC Thyroid Uptake Measurement","PX-3410084","CDM",78012,"CPT",341,"RC",{"$nulls":6},"both",null,null,1205.49,1205.49,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Application Long Arm Splint Shoulder Hand","PX-29105","CDM",29105,"CPT",521,"RC",{"$nulls":6},"both",null,null,473.37,473.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},38.4,80.64,null,null,"facility"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 2nd Level","PX-64494","CDM",64494,"CPT",521,"RC",{"$nulls":6},"both",null,null,2721.55,2721.55,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},47.86,87.81,null,null,"facility"]
["HC Inj Paravert F Jnt L/S 2 Lev","PX-4903057","CDM",64494,"CPT",360,"RC",{"$nulls":6},"both",null,null,2605.35,2605.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Colect W/Coloproctostomy","PX-4902528","CDM",44145,"CPT",360,"RC",{"$nulls":6},"both",null,null,15243,15243,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Chemodenerv Musc Migraine","PX-4902655","CDM",64615,"CPT",360,"RC",{"$nulls":6},"both",null,null,846.6,846.6,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Egd Transoral Biopsy Single/Multiple","PX-43239","CDM",43239,"CPT",521,"RC",{"$nulls":6},"both",null,null,2812.68,2812.68,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},129.51,364.61,null,null,"facility"]
["Lh Thc/Ratio Urine","PX-LH300874","CDM",80349,"CPT",300,"RC",{"$nulls":6},"both",null,null,343.29,343.29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Ot Eval","PX-4340012","CDM",97167,"CPT",434,"RC",{"$nulls":6},"both",null,null,296.19,296.19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["MRI Brain W/O Dye","PX-6110020","CDM",70557,"CPT",611,"RC",{"$nulls":6},"both",null,null,1644.9,1644.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Urinalysis Auto W/O Micro","PX-LH300893","CDM",81003,"CPT",300,"RC",{"$nulls":6},"both",null,null,19,19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh O&P Smear,Complex Stain","PX-LH300979","CDM",87209,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Phosphatidylserine Antibodies (Igg,Iga,Igm)","PX-LH300998","CDM",86148,"CPT",300,"RC",{"$nulls":6},"both",null,null,48.21,48.21,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Sickle Cell Screen","PX-LH301007","CDM",85660,"CPT",300,"RC",{"$nulls":6},"both",null,null,16.53,16.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Injection Aa&/Strd Suprascapular Nerve","PX-64418","CDM",64418,"CPT",521,"RC",{"$nulls":6},"both",null,null,247.14,247.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},52.13,82.91,null,null,"facility"]
["Lh Drug Test Pres,Chem Analyzer","PX-LH301037","CDM",80307,"CPT",300,"RC",{"$nulls":6},"both",null,null,186.42,186.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Diagnostic Lumbar Spinal Puncture W/Fluor or CT","PX-62328","CDM",62328,"CPT",521,"RC",{"$nulls":6},"both",null,null,641.94,641.94,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},79.83,214.73,null,null,"facility"]
["Lh Trichomonas Vaginalis Rna, Amp Qual","PX-LH301053","CDM",87661,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hepatitis a Ab, Total","PX-LH301073","CDM",86708,"CPT",300,"RC",{"$nulls":6},"both",null,null,98,98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen","PX-88142","CDM",88142,"CPT",521,"RC",{"$nulls":6},"both",null,null,60.78,60.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},20.26,20.26,null,null,"facility"]
["Lh Kappa/Lambda Light Chains, Free With Ratio","PX-LH83521","CDM",83521,"CPT",300,"RC",{"$nulls":6},"both",null,null,51.81,51.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Iaadiadoo Not Otherwise Specified","PX-LH87899","CDM",87899,"CPT",300,"RC",{"$nulls":6},"both",null,null,95,95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hep B Surface Ag Neutrlzj Ia","PX-LH87341","CDM",87341,"CPT",300,"RC",{"$nulls":6},"both",null,null,78,78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Influenza a/B Each Ag Ia","PX-LH87400","CDM",87400,"CPT",300,"RC",{"$nulls":6},"both",null,null,42.39,42.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Sclerotherapy Spider Veins","PX-3200000","CDM",36468,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Xr-Lower Spine","PX-3200026","CDM",72114,"CPT",320,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Xray Knee","PX-3200068","CDM",73562,"CPT",320,"RC",{"$nulls":6},"both",null,null,264.15,264.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Fluro Guid Ndl Plcmnt","PX-3200204","CDM",77002,"CPT",320,"RC",{"$nulls":6},"both",null,null,617.2,617.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CT-Neck","PX-3500002","CDM",70492,"CPT",350,"RC",{"$nulls":6},"both",null,null,2070,2070,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["CT-Ear","PX-3510003","CDM",70480,"CPT",351,"RC",{"$nulls":6},"both",null,null,1804,1804,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["US Renal Complete","PX-4020009","CDM",76770,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Traction","PX-4200004","CDM",97012,"CPT",420,"RC",{"$nulls":6},"both",null,null,40.65,40.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Scalp,Extr 1.1-2.5","PX-4500007","CDM",13120,"CPT",360,"RC",{"$nulls":6},"both",null,null,1836.39,1836.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Apply Long Leg Cast","PX-4500051","CDM",29345,"CPT",360,"RC",{"$nulls":6},"both",null,null,767.64,767.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Critical Care 1st Hour","PX-4500101","CDM",99291,"CPT",450,"RC",{"$nulls":6},"both",null,null,2057,2057,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Echo Transthoracic","PX-4800017","CDM",93350,"CPT",483,"RC",{"$nulls":6},"both",null,null,1644.9,1644.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Shav Skin Les >21mm Remaindr Body","PX-4900037","CDM",11308,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Exc Skin Malig <5cm Face,Facial","PX-4900077","CDM",11640,"CPT",360,"RC",{"$nulls":6},"both",null,null,2011.08,2011.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Repr Superf Wnd Face <2.5cm","PX-4900114","CDM",12011,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Repr Cmpl Wnd Head,Fac,Hand 1.1-2.5","PX-4900144","CDM",13131,"CPT",360,"RC",{"$nulls":6},"both",null,null,1139.76,1139.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Destruct Premalg Lesion","PX-4900239","CDM",17000,"CPT",360,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Closed Rx Dist Rad/Ulna Fx","PX-4900574","CDM",25600,"CPT",360,"RC",{"$nulls":6},"both",null,null,711,711,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Closed Rx Weight Bear Dist Tibia","PX-4900847","CDM",27824,"CPT",360,"RC",{"$nulls":6},"both",null,null,674.07,674.07,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Control Nose Bleed,Cmplx","PX-4901081","CDM",30903,"CPT",360,"RC",{"$nulls":6},"both",null,null,365.13,365.13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["HC Remove Tunnel Cv Access Device, W Port/Pump","PX-4901265","CDM",36590,"CPT",360,"RC",{"$nulls":6},"both",null,null,4577.79,4577.79,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Incision & Drainage Abscess Simple/Single","PX-10060","CDM",10060,"CPT",521,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},103.38,123.35,null,null,"facility"]
["HC Intercostal Nerve Block,Sng","PX-4901668","CDM",64420,"CPT",360,"RC",{"$nulls":6},"both",null,null,1976.7,1976.7,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L >4.0 Cm","PX-11406","CDM",11406,"CPT",521,"RC",{"$nulls":6},"both",null,null,905.91,905.91,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},234.82,304.89,null,null,"facility"]
["HC Followup Surgery of Eye","PX-4901769","CDM",66250,"CPT",360,"RC",{"$nulls":6},"both",null,null,6679.44,6679.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M > 4.0cm","PX-11446","CDM",11446,"CPT",521,"RC",{"$nulls":6},"both",null,null,1095.27,1095.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},301.3,368.1,null,null,"facility"]
["HC Mra Head W/WO Dye","PX-6100005","CDM",70546,"CPT",610,"RC",{"$nulls":6},"both",null,null,2458,2458,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["MRI-Tmj","PX-6110000","CDM",70336,"CPT",611,"RC",{"$nulls":6},"both",null,null,2700,2700,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Evacuation Subungual Hematoma","PX-11740","CDM",11740,"CPT",521,"RC",{"$nulls":6},"both",null,null,386.7,386.7,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},31.29,56.5,null,null,"facility"]
["Repair Nail Bed","PX-11760","CDM",11760,"CPT",521,"RC",{"$nulls":6},"both",null,null,534.63,534.63,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},104.72,179.05,null,null,"facility"]
["Infusion Ea Addl Hr","PX-9400006","CDM",96366,"CPT",260,"RC",{"$nulls":6},"both",null,null,138.42,138.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm","PX-12004","CDM",12004,"CPT",521,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},67.45,126.72,null,null,"facility"]
["Repair Intermediate F/E/E/N/L&/Muc 5.1-7.5 Cm","PX-12053","CDM",12053,"CPT",521,"RC",{"$nulls":6},"both",null,null,1049.4,1049.4,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},204.55,351.57,null,null,"facility"]
["US Breast Unilateral Cmplt","PX-4020104","CDM",76641,"CPT",402,"RC",{"$nulls":6},"both",null,null,319.02,319.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Destruction Premalignant Lesion 1st","PX-17000","CDM",17000,"CPT",521,"RC",{"$nulls":6},"both",null,null,596.1,596.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},53.41,65.85,null,null,"facility"]
["HC Destroy C/Th Facet Jnt Addl","PX-4902352","CDM",64634,"CPT",360,"RC",{"$nulls":6},"both",null,null,843.61,843.61,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hdl Cholesterol","PX-LH300038","CDM",83718,"CPT",300,"RC",{"$nulls":6},"both",null,null,24.57,24.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Culture Ear Ref","PX-LH300049","CDM",87070,"CPT",300,"RC",{"$nulls":6},"both",null,null,69,69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hct WC","PX-LH300075","CDM",85014,"CPT",300,"RC",{"$nulls":6},"both",null,null,20,20,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Ca 125 Ref","PX-LH300137","CDM",86304,"CPT",300,"RC",{"$nulls":6},"both",null,null,160,160,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Estriol Ref","PX-LH300162","CDM",82677,"CPT",300,"RC",{"$nulls":6},"both",null,null,188,188,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hepatitis Profile Acute","PX-LH300184","CDM",80074,"CPT",300,"RC",{"$nulls":6},"both",null,null,142.89,142.89,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hva Ref","PX-LH300196","CDM",83150,"CPT",300,"RC",{"$nulls":6},"both",null,null,67.23,67.23,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Porphobilinoge Quant","PX-LH300227","CDM",84110,"CPT",300,"RC",{"$nulls":6},"both",null,null,25.32,25.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Protein Electro Ser Ref","PX-LH300334","CDM",84165,"CPT",300,"RC",{"$nulls":6},"both",null,null,83,83,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Xylose Tolerance","PX-LH300369","CDM",84620,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.73,38.73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Acid Phos Prost","PX-LH300391","CDM",84066,"CPT",300,"RC",{"$nulls":6},"both",null,null,28.98,28.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Renin, Serum R","PX-LH300402","CDM",84244,"CPT",300,"RC",{"$nulls":6},"both",null,null,172,172,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hep C Rna Pcr R","PX-LH300424","CDM",87521,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Sputum to State","PX-LH300446","CDM",87118,"CPT",300,"RC",{"$nulls":6},"both",null,null,43.83,43.83,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Pth/Rp Ref","PX-LH300483","CDM",83519,"CPT",300,"RC",{"$nulls":6},"both",null,null,65,65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Pro-1 Basic Metabolic","PX-LH300508","CDM",80048,"CPT",300,"RC",{"$nulls":6},"both",null,null,68,68,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Renin Plasma Ref","PX-LH300543","CDM",84244,"CPT",300,"RC",{"$nulls":6},"both",null,null,172,172,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Wbc & Diff Fluid Ref","PX-LH300566","CDM",89051,"CPT",300,"RC",{"$nulls":6},"both",null,null,42,42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Bk Polumd Virus Dna/Rna Amp Ref","PX-LH300591","CDM",87798,"CPT",300,"RC",{"$nulls":6},"both",null,null,105.27,105.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Scleroderma Anitbody Scl-70 Ref","PX-LH300602","CDM",86235,"CPT",300,"RC",{"$nulls":6},"both",null,null,139,139,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Zinc Ref","PX-LH300631","CDM",84630,"CPT",300,"RC",{"$nulls":6},"both",null,null,90,90,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Hepatitis E Igg Ref","PX-LH300646","CDM",86790,"CPT",300,"RC",{"$nulls":6},"both",null,null,38.64,38.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Vitamin B 6 Ref","PX-LH300680","CDM",84207,"CPT",300,"RC",{"$nulls":6},"both",null,null,218,218,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Lysozyme Serum Ref","PX-LH300703","CDM",85549,"CPT",300,"RC",{"$nulls":6},"both",null,null,56.25,56.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Growth Hormone Ref","PX-LH300714","CDM",83003,"CPT",300,"RC",{"$nulls":6},"both",null,null,50.01,50.01,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Rocky Mountain Sf(Spotted Fever)","PX-LH300736","CDM",86757,"CPT",300,"RC",{"$nulls":6},"both",null,null,58.05,58.05,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Venipuncture X 3","PX-LH300762","CDM",36415,"CPT",300,"RC",{"$nulls":6},"both",null,null,30.5,30.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Molecule Nucleic Amplification 2 Sequenc","PX-LH700003","CDM",86334,"CPT",300,"RC",{"$nulls":6},"both",null,null,174,174,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Clsd Tx Shoulder Dislc W/Manipulation W/O Anes","PX-23650","CDM",23650,"CPT",521,"RC",{"$nulls":6},"both",null,null,978.72,978.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":5},296.25,329.65,null,null,"facility"]
["Lh Strapping Elbow/Wrist","PX-LH461032","CDM",29260,"HCPCS",270,"RC",{"$nulls":6},"both",null,null,48.9,48.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Anesthesia Egd","PX-LH4400740","CDM",740,"CPT",370,"RC",{"$nulls":6},"both",null,null,61.32,61.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Diabetic Teach 2-4 Pts 30 Min","PX-LH98961","CDM",98961,"CPT",942,"RC",{"$nulls":6},"both",null,null,45.69,45.69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh RBC Leuko Reduc Unit 6","PX-LH300115","CDM","P9016","HCPCS",390,"RC",{"$nulls":6},"both",null,null,542.46,542.46,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Lh Strapping - Ankle","PX-LH461018","CDM",29540,"CPT",420,"RC",{"$nulls":6},"both",null,null,80.7,80.7,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",{"$nulls":9},"facility"]
["Manipulation Finger Joint Under Anes Each Joint","PX-26340","CDM",26340,"CPT",{"$nulls":8},"both",null,null,1053.39,1053.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},353.6,353.6,null,null,"professional"]
["Initial Nursing Facility Care Hi Mdm 50 Minutes","PX-99306","CDM",99306,"CPT",{"$nulls":8},"both",null,null,518.46,518.46,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},173.84,173.84,null,null,"professional"]
["Strapping Unna Boot","PX-29580","CDM",29580,"CPT",{"$nulls":8},"both",null,null,184.35,184.35,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},24.43,61.76,null,null,"professional"]
["Control Nasal Hemorrhage Anterior Simple","PX-30901","CDM",30901,"CPT",{"$nulls":8},"both",null,null,450.15,450.15,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.33,150.89,null,null,"professional"]
["Egd Transoral Biopsy Single/Multiple","PX-43239","CDM",43239,"CPT",{"$nulls":8},"both",null,null,1089.84,1089.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},129.51,364.61,null,null,"professional"]
["Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible","PX-49505","CDM",49505,"CPT",{"$nulls":8},"both",null,null,1432.02,1432.02,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},486.22,486.22,null,null,"professional"]
["Injection Aa&/Strd Suprascapular Nerve","PX-64418","CDM",64418,"CPT",{"$nulls":8},"both",null,null,247.14,247.14,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},52.13,82.91,null,null,"professional"]
["Destruction Neurolytic Agt Genicular Nerve W/Img","PX-64624","CDM",64624,"CPT",{"$nulls":8},"both",null,null,1131.42,1131.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},139.13,378.16,null,null,"professional"]
["Ecg Routine Ecg W/Least 12 Lds W/I&R","PX-93000","CDM",93000,"CPT",{"$nulls":8},"both",null,null,41.04,41.04,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},13.76,13.76,null,null,"professional"]
["Hospital IP/Obs Discharge Day Mgmt > 30 Min","PX-99239","CDM",99239,"CPT",{"$nulls":8},"both",null,null,324.87,324.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":4},160.88,108.96,108.96,null,null,"professional"]
["Initial Preventive Medicine New Pt Age 12-17 Yr","PX-99384","CDM",99384,"CPT",{"$nulls":8},"both",null,null,390.96,390.96,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"professional"]
["Unlisted Evaluation and Management Service","PX-99499","CDM",99499,"CPT",{"$nulls":8},"both",null,null,115.91,115.91,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"professional"]
["Removal of Sutures","PX-S0630","CDM","S0630","HCPCS",{"$nulls":8},"both",null,null,386,386,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"professional"]
["Paring/Cutting Benign Hyperkeratotic Lesion 1","PX-11055","CDM",11055,"CPT",{"$nulls":8},"both",null,null,208.41,208.41,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},14.59,69.6,null,null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm","PX-11601","CDM",11601,"CPT",{"$nulls":8},"both",null,null,661.65,661.65,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},141.76,221.65,null,null,"professional"]
["Repair Nail Bed","PX-11760","CDM",11760,"CPT",{"$nulls":8},"both",null,null,534.63,534.63,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},104.72,179.05,null,null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral","PX-64636","CDM",64636,"CPT",{"$nulls":8},"both",null,null,700.59,700.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.24,234.02,null,null,"professional"]
["Repair Intermediate N/H/F/Xtrnl Gent 7.6-12.5cm","PX-12044","CDM",12044,"CPT",{"$nulls":8},"both",null,null,1103.34,1103.34,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},203.1,370.1,null,null,"professional"]
["PPPS, initial visit","PX-G0438","CDM","G0438","HCPCS",{"$nulls":8},"both",null,null,477.9,477.9,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},136.04,160.05,null,null,"professional"]
["Chronic Care Mgmt Svcs Staff 1st 20 Min Cal Mo","PX-99490","CDM",99490,"CPT",{"$nulls":8},"both",null,null,180.42,180.42,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},47.68,60.45,null,null,"professional"]
["Closed Tx Radial Shaft Fracture W/O Manipulation","PX-25500","CDM",25500,"CPT",{"$nulls":8},"both",null,null,849.81,849.81,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},257.65,285.48,null,null,"professional"]
["Perq Drainage Pleura Insert Cath W/O Imaging","PX-32556","CDM",32556,"CPT",{"$nulls":8},"both",null,null,2148.48,2148.48,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",186.69,113.99,717.8,"other","Facility","professional"]
["Closed Tx Bimalleolar Ankle Fracture W/Manj","PX-27810","CDM",27810,"CPT",{"$nulls":8},"both",null,null,1383.12,1383.12,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",656.73,417.12,465.91,"other","Facility","professional"]
["Intubation Endotracheal Emergency Procedure","PX-31500","CDM",31500,"CPT",{"$nulls":8},"both",null,null,383.52,383.52,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",213.42,129.74,129.74,"other","Facility","professional"]
["Skyla, 13.5 mg","PX-J7301","CDM","J7301","HCPCS",{"$nulls":8},"both",null,null,2908,2908,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",675.75,null,null,"other","Facility","professional"]
["Colsc Flx W/Removal Lesion by Hot Bx Forceps","PX-45384","CDM",45384,"CPT",{"$nulls":8},"both",null,null,1398.51,1398.51,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",344.56,210.89,468.91,"other","Facility","professional"]
["Punch Biopsy Skin Ea Sep/Additional Lesion","PX-11105","CDM",11105,"CPT",{"$nulls":8},"both",null,null,172.2,172.2,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",38.57,23.94,57.66,"other","Facility","professional"]
["Dstrj Neurolytic Agent Other Peripheral Nerve","PX-64640","CDM",64640,"CPT",{"$nulls":8},"both",null,null,720.06,720.06,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",178.97,113.25,240.95,"other","Facility","professional"]
["Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen","PX-88142","CDM",88142,"CPT",{"$nulls":8},"both",null,null,60.78,60.78,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",16.13,20.26,20.26,"other","Facility","professional"]
["Vital Capacity Total Separate Procedure|PROFESSIONAL COMPONENT","PX-94150","CDM",94150,"CPT",{"$nulls":8},"both",null,null,74.66,74.66,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",26,null,null,"Minimum of percent of billed and fee schedule amou",4.98,null,null,"other","Facility","professional"]
["Office/Outpatient Est Pt May Not Req Phys/Qhp","PX-99211","CDM",99211,"CPT",{"$nulls":8},"both",null,null,68.16,68.16,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",11.69,8.36,22.76,"other","Facility","professional"]
["Critical Care Ill/Injured Patient Init 30-74 Min","PX-99291","CDM",99291,"CPT",{"$nulls":8},"both",null,null,778.05,778.05,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",284.54,199.97,261.21,"other","Facility","professional"]
["Injection,onabotulinumtoxinA","PX-J0585","CDM","J0585","HCPCS",{"$nulls":8},"both",null,null,18.96,18.96,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",4.69,6.41,6.41,"other","Facility","professional"]
["Phys/Qhp Telephone Evaluation 11-20 Min","PX-99442","CDM",99442,"CPT",{"$nulls":8},"both",null,null,261.72,261.72,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",87.2,62.43,74.49,"other","Facility","professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm","PX-11307","CDM",11307,"CPT",{"$nulls":8},"both",null,null,401.37,401.37,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",94.63,58.68,134.32,"other","Facility","professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L >4.0 Cm","PX-11406","CDM",11406,"CPT",{"$nulls":8},"both",null,null,905.91,905.91,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",375.93,234.82,304.89,"other","Facility","professional"]
["Excision Malignant Lesion S/N/H/F/G 2.1-3.0 Cm","PX-11623","CDM",11623,"CPT",{"$nulls":8},"both",null,null,850.98,850.98,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",314.22,198.33,285.42,"other","Facility","professional"]
["Simple Repair F/E/E/N/L/M 2.5cm/<","PX-12011","CDM",12011,"CPT",{"$nulls":8},"both",null,null,319.29,319.29,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",83.83,51.03,107.35,"other","Facility","professional"]
["Repair Complex Trunk 1.1-2.5 Cm","PX-13100","CDM",13100,"CPT",{"$nulls":8},"both",null,null,981.84,981.84,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",300.86,189.8,328.96,"other","Facility","professional"]
["Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US","PX-20606","CDM",20606,"CPT",{"$nulls":8},"both",null,null,258.33,258.33,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",78.17,48.7,86.68,"other","Facility","professional"]
["Clsd Tx Shoulder Dislc W/Manipulation Req Anes","PX-23655","CDM",23655,"CPT",{"$nulls":8},"both",null,null,1178.85,1178.85,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",631.02,397.24,397.24,"other","Facility","professional"]
["Drainage Finger Abscess Simple","PX-26010","CDM",26010,"CPT",{"$nulls":8},"both",null,null,1001.31,1001.31,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},136.53,334.96,null,null,"professional"]
["Removal Foreign Body Deep Thigh/Knee","PX-27372","CDM",27372,"CPT",{"$nulls":8},"both",null,null,1674.27,1674.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},381.6,563,null,null,"professional"]
["Perq Drainage Pleura Insert Cath W/O Imaging","PX-32556","CDM",32556,"CPT",{"$nulls":8},"both",null,null,2148.48,2148.48,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},113.99,717.8,null,null,"professional"]
["Closed Tx Bimalleolar Ankle Fracture W/Manj","PX-27810","CDM",27810,"CPT",{"$nulls":8},"both",null,null,1383.12,1383.12,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},417.12,465.91,null,null,"professional"]
["Cltx Tarsal Dislc Oth/Thn Talotarsal W/O Anes","PX-28540","CDM",28540,"CPT",{"$nulls":8},"both",null,null,583.98,583.98,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},175.11,195.41,null,null,"professional"]
["Application Short Leg Cast Walking/Ambulatory","PX-29425","CDM",29425,"CPT",{"$nulls":8},"both",null,null,219.87,219.87,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},51.79,73.73,null,null,"professional"]
["Pcv13 Vaccine for Intramuscular Use","PX-90670","CDM",90670,"CPT",{"$nulls":8},"both",null,null,95.76,95.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},257.99,257.99,null,null,"professional"]
["Ctrl Nsl Hemrrg Pst Nasal Packs&/Cautery Subsq","PX-30906","CDM",30906,"CPT",{"$nulls":8},"both",null,null,1083.78,1083.78,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},123.34,363.03,null,null,"professional"]
["PR Marcaine .5%","PX-J3490.25","CDM","J3490","HCPCS",{"$nulls":8},"both",null,null,0.39,0.39,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"professional"]
["Proctosgmdsc Rgd Dx W/WO Collj Spec Br/Wa Spx","PX-45300","CDM",45300,"CPT",{"$nulls":8},"both",null,null,370.29,370.29,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},45.1,124.01,null,null,"professional"]
["Anoscopy Dx W/Collj Spec Br/Wa Spx When Prfrmd","PX-46600","CDM",46600,"CPT",{"$nulls":8},"both",null,null,342.27,342.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},39.18,114.49,null,null,"professional"]
["Change Cystostomy Tube Simple","PX-51705","CDM",51705,"CPT",{"$nulls":8},"both",null,null,281.13,281.13,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},48.69,94.2,null,null,"professional"]
["Removal Intrauterine Device Iud","PX-58301","CDM",58301,"CPT",{"$nulls":8},"both",null,null,314.37,314.37,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},61.51,105.72,null,null,"professional"]
["Injection Aa&/Strd Pudendal Nerve","PX-64430","CDM",64430,"CPT",{"$nulls":8},"both",null,null,282.51,282.51,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},51.48,94.7,null,null,"professional"]
["Dstrj Neurolytic Agent Other Peripheral Nerve","PX-64640","CDM",64640,"CPT",{"$nulls":8},"both",null,null,720.06,720.06,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},113.25,240.95,null,null,"professional"]
["Therapeutic Spinal Pnxr Drainage CSF W/Fluor/CT","PX-62329","CDM",62329,"CPT",{"$nulls":8},"both",null,null,750.96,750.96,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},96.43,251.64,null,null,"professional"]
["Dis site tele svcs rhc/fqhc","PX-G2025","CDM","G2025","HCPCS",{"$nulls":8},"both",null,null,285.81,285.81,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only","PX-93017","CDM",93017,"CPT",{"$nulls":8},"both",null,null,109.8,109.8,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},36.68,36.68,null,null,"professional"]
["Office/Outpatient New Sf Mdm 15 Minutes","PX-99202","CDM",99202,"CPT",{"$nulls":8},"both",null,null,208.32,208.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":4},60.3,44.9,59.32,null,null,"professional"]
["1st Hospital IP/Obs Care High Mdm 75 Minutes","PX-99223","CDM",99223,"CPT",{"$nulls":8},"both",null,null,489.12,489.12,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":4},166.92,164.19,164.19,null,null,"professional"]
["Hospital IP/Obs Care Same Date High Mdm 85 Min","PX-99236","CDM",99236,"CPT",{"$nulls":8},"both",null,null,587.64,587.64,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},197.3,197.3,null,null,"professional"]
["Nursing Facility Dschrg Mgmt 30 Min/< Tot Time","PX-99315","CDM",99315,"CPT",{"$nulls":8},"both",null,null,232.62,232.62,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},66.29,77.99,null,null,"professional"]
["Initial Preventive Medicine New Pt Age 18-39yrs","PX-99385","CDM",99385,"CPT",{"$nulls":8},"both",null,null,380.16,380.16,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"professional"]
["Ca Screen;Pelvic/Breast Exam","PX-G0101","CDM","G0101","HCPCS",{"$nulls":8},"both",null,null,111.66,111.66,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},25.74,37.53,null,null,"professional"]
["Ondansetron Hcl Injection","PX-J2405","CDM","J2405","HCPCS",{"$nulls":8},"both",null,null,0.3,0.3,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},0.09,0.09,null,null,"professional"]
["Phys/Qhp Telephone Evaluation 21-30 Min","PX-99443","CDM",99443,"CPT",{"$nulls":8},"both",null,null,369.69,369.69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},92.42,123.85,null,null,"professional"]
["Debridement Muscle &/Fascia 1st 20 Sq Cm/<","PX-11043","CDM",11043,"CPT",{"$nulls":8},"both",null,null,662.37,662.37,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},143.64,222.56,null,null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm","PX-11308","CDM",11308,"CPT",{"$nulls":8},"both",null,null,422.37,422.37,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},65.72,141.36,null,null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm","PX-11401","CDM",11401,"CPT",{"$nulls":8},"both",null,null,452.97,452.97,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},101.92,151.69,null,null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M 0.5cm/<","PX-11440","CDM",11440,"CPT",{"$nulls":8},"both",null,null,418.68,418.68,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},104.35,140.04,null,null,"professional"]
["Excision Malignant Lesion S/N/H/F/G >4.0 Cm","PX-11626","CDM",11626,"CPT",{"$nulls":8},"both",null,null,1152.69,1152.69,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},272.37,387.63,null,null,"professional"]
["Excision Nail Matrix Permanent Removal","PX-11750","CDM",11750,"CPT",{"$nulls":8},"both",null,null,467.55,467.55,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},98.14,156.43,null,null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral","PX-64635","CDM",64635,"CPT",{"$nulls":8},"both",null,null,5858.31,5858.31,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},183.22,429.13,null,null,"professional"]
["Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<","PX-12001","CDM",12001,"CPT",{"$nulls":8},"both",null,null,269.28,269.28,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},41.35,90.46,null,null,"professional"]
["Repair Intermediate S/a/T/E 2.6-7.5 Cm","PX-12032","CDM",12032,"CPT",{"$nulls":8},"both",null,null,880.23,880.23,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},182.06,294.7,null,null,"professional"]
["Repair Intermediate F/E/E/N/L&/Muc 7.6-12.5 Cm","PX-12054","CDM",12054,"CPT",{"$nulls":8},"both",null,null,1099.08,1099.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},207.56,368.66,null,null,"professional"]
["Splt Agrft F/S/N/H/F/G/M/Dgt 1st 100 Sqcm/</1%","PX-15120","CDM",15120,"CPT",{"$nulls":8},"both",null,null,2399.61,2399.61,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},652.38,807.26,null,null,"professional"]
["Initial Tx 1st Degree Burn Local Tx","PX-16000","CDM",16000,"CPT",{"$nulls":8},"both",null,null,227.25,227.25,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},42.32,76.37,null,null,"professional"]
["Destruction Premalignant Lesion 2-14 Ea","PX-17003","CDM",17003,"CPT",{"$nulls":8},"both",null,null,19.65,19.65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},1.96,5.57,null,null,"professional"]
["Excision Tumor Soft Tissue Back/Flank Subq <3cm","PX-21930","CDM",21930,"CPT",{"$nulls":8},"both",null,null,1430.52,1430.52,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},346.38,481.61,null,null,"professional"]
["Treatment Closed Elbow Dislocation W/O Anes","PX-24600","CDM",24600,"CPT",{"$nulls":8},"both",null,null,1101.93,1101.93,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},334.66,371.33,null,null,"professional"]
["Closed Tx Ulnar Fracture Proximal End W/Manj","PX-24675","CDM",24675,"CPT",{"$nulls":8},"both",null,null,1347.57,1347.57,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},409.03,453.57,null,null,"professional"]
["Removal Foreign Body Deep Thigh/Knee","PX-27372","CDM",27372,"CPT",{"$nulls":8},"both",null,null,1674.27,1674.27,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},381.6,563,null,null,"professional"]
["Initial Nursing Facility Care Sf/Low Mdm 25 Min","PX-99304","CDM",99304,"CPT",{"$nulls":8},"both",null,null,228.09,228.09,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},76.52,76.52,null,null,"professional"]
["Pcv13 Vaccine for Intramuscular Use","PX-90670","CDM",90670,"CPT",{"$nulls":8},"both",null,null,95.76,95.76,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},257.99,257.99,null,null,"professional"]
["Esophagoscopy Flexible Transoral Diagnostic","PX-43200","CDM",43200,"CPT",{"$nulls":8},"both",null,null,762.69,762.69,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},82.31,255.2,null,null,"professional"]
["Proctosgmdsc Rgd Dx W/WO Collj Spec Br/Wa Spx","PX-45300","CDM",45300,"CPT",{"$nulls":8},"both",null,null,370.29,370.29,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},45.1,124.01,null,null,"professional"]
["Change Cystostomy Tube Simple","PX-51705","CDM",51705,"CPT",{"$nulls":8},"both",null,null,281.13,281.13,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},48.69,94.2,null,null,"professional"]
["Injection Aa&/Strd Axillary Nerve W/Img Gdn","PX-64417","CDM",64417,"CPT",{"$nulls":8},"both",null,null,464.61,464.61,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},60.16,155.44,null,null,"professional"]
["Dis site tele svcs rhc/fqhc","PX-G2025","CDM","G2025","HCPCS",{"$nulls":8},"both",null,null,285.81,285.81,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"professional"]
["Pressurized/Nonpressurized Inhalation Treatment","PX-94640","CDM",94640,"CPT",{"$nulls":8},"both",null,null,22.98,22.98,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},7.7,7.7,null,null,"professional"]
["Office/Outpatient Established Sf Mdm 10 Min","PX-99212","CDM",99212,"CPT",{"$nulls":8},"both",null,null,163.35,163.35,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},33.43,46.51,null,null,"professional"]
["Critical Care Ill/Injured Patient Addl 30 Min","PX-99292","CDM",99292,"CPT",{"$nulls":8},"both",null,null,337.71,337.71,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},100.49,113.59,null,null,"professional"]
["Ipratropium Brom Inh Sol U D","PX-J7644","CDM","J7644","HCPCS",{"$nulls":8},"both",null,null,0.96,0.96,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},0.36,0.36,null,null,"professional"]
["Phys/Qhp Telephone Evaluation 21-30 Min","PX-99443","CDM",99443,"CPT",{"$nulls":8},"both",null,null,369.69,369.69,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},92.42,123.85,null,null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm","PX-11308","CDM",11308,"CPT",{"$nulls":8},"both",null,null,422.37,422.37,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},65.72,141.36,null,null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M > 4.0cm","PX-11446","CDM",11446,"CPT",{"$nulls":8},"both",null,null,1095.27,1095.27,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},301.3,368.1,null,null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral","PX-64635","CDM",64635,"CPT",{"$nulls":8},"both",null,null,5858.31,5858.31,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},183.22,429.13,null,null,"professional"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.6-7.5 Cm","PX-12042","CDM",12042,"CPT",{"$nulls":8},"both",null,null,896.49,896.49,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},186.66,300.28,null,null,"professional"]
["Repair Complex Scalp/Arm/Leg 2.6-7.5 Cm","PX-13121","CDM",13121,"CPT",{"$nulls":8},"both",null,null,1224.93,1224.93,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},244.04,410.38,null,null,"professional"]
["Initial Tx 1st Degree Burn Local Tx","PX-16000","CDM",16000,"CPT",{"$nulls":8},"both",null,null,227.25,227.25,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},42.32,76.37,null,null,"professional"]
["9vhpv Vacc 2/3 Dose Sched Im Use","PX-90651","CDM",90651,"CPT",{"$nulls":8},"both",null,null,372,372,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":9},"professional"]
["Cltx Metacarpophalangeal Dislc W/Manj W/O Anes","PX-26700","CDM",26700,"CPT",{"$nulls":8},"both",null,null,999.06,999.06,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},308.87,336.38,null,null,"professional"]
["Psychotherapy for Crisis Initial 60 Minutes","PX-90839","CDM",90839,"CPT",{"$nulls":8},"both",null,null,426.15,426.15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},125.14,142.49,null,null,"professional"]
["Removal Foreign Body Foot Subcutaneous","PX-28190","CDM",28190,"CPT",{"$nulls":8},"both",null,null,697.11,697.11,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},127.81,233.25,null,null,"professional"]
["Removal/Bivalving Full Arm/Full Leg Cast","PX-29705","CDM",29705,"CPT",{"$nulls":8},"both",null,null,181.32,181.32,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},41.65,60.97,null,null,"professional"]
["Iiv4 Vacc Split Virus 0.5 Ml Dos for Im Use","PX-90688","CDM",90688,"CPT",{"$nulls":8},"both",null,null,62.61,62.61,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"professional"]
["Rpr Ingun Hernia Sliding Any Age","PX-49525","CDM",49525,"CPT",{"$nulls":8},"both",null,null,1567.38,1567.38,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},532.36,532.36,null,null,"professional"]
["Endometrial Bx W/WO Endocervix Bx W/O Dilat Spx","PX-58100","CDM",58100,"CPT",{"$nulls":8},"both",null,null,288.45,288.45,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},58.72,97.03,null,null,"professional"]
["Injx Anes Celiac Plexus W/WO Radiologic Monitrng","PX-64530","CDM",64530,"CPT",{"$nulls":8},"both",null,null,664.77,664.77,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},89.97,222.25,null,null,"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg W/Si&R","PX-93015","CDM",93015,"CPT",{"$nulls":8},"both",null,null,209.76,209.76,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},70.09,70.09,null,null,"professional"]
["1st Hospital IP/Obs Care Sf/Low Mdm 40 Minutes","PX-99221","CDM",99221,"CPT",{"$nulls":8},"both",null,null,230.73,230.73,"UMR [623]","UMR LABORCARE [152]",{"$nulls":4},151.74,77.7,77.7,null,null,"professional"]
["IP/Obs Consltj New/Est Pt Sf Mdm 35 Minutes","PX-99252","CDM",99252,"CPT",{"$nulls":8},"both",null,null,207.27,207.27,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"professional"]
["Initial Preventive Medicine New Pt Age 18-39yrs","PX-99385","CDM",99385,"CPT",{"$nulls":8},"both",null,null,380.16,380.16,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"professional"]
["Dexamethasone 1mg Inj","PX-J1100","CDM","J1100","HCPCS",{"$nulls":8},"both",null,null,0.33,0.33,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},0.11,0.11,null,null,"professional"]
["Rmvl Skin Tags Mlt Fibrq Tags Any Ea Addl 10","PX-11201","CDM",11201,"CPT",{"$nulls":8},"both",null,null,52.2,52.2,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},15.24,17.53,null,null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 2.1-3.0cm","PX-11423","CDM",11423,"CPT",{"$nulls":8},"both",null,null,592.65,592.65,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},150.94,198.74,null,null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 0.6-1.0 Cm","PX-11641","CDM",11641,"CPT",{"$nulls":8},"both",null,null,684.99,684.99,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},148.32,229.52,null,null,"professional"]
["Wedge Excision Skin Nail Fold","PX-11765","CDM",11765,"CPT",{"$nulls":8},"both",null,null,485.1,485.1,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},90.1,162.14,null,null,"professional"]
["Simple Repair F/E/E/N/L/M 7.6cm-12.5 Cm","PX-12015","CDM",12015,"CPT",{"$nulls":8},"both",null,null,485.55,485.55,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},85.69,163.62,null,null,"professional"]
["Penicillin g benzathine inj","PX-J0561","CDM","J0561","HCPCS",{"$nulls":8},"both",null,null,15,15,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},24.37,24.37,null,null,"professional"]
["Injection 1 Tendon Sheath/Ligament Aponeurosis","PX-20550","CDM",20550,"CPT",{"$nulls":8},"both",null,null,164.85,164.85,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},36.4,55.39,null,null,"professional"]
["Continuous Glucose Monitoring Analysis I&R","PX-95251","CDM",95251,"CPT",{"$nulls":8},"both",null,null,98.76,98.76,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},33.09,33.09,null,null,"professional"]
["Cltx Tibial Shaft Fx W/Manj W/WO Skel Tracj","PX-27752","CDM",27752,"CPT",{"$nulls":8},"both",null,null,1547.43,1547.43,"OPTUM [1029]","VA CCN OPTUM [885]",null,474.04,null,null,474.04,474.04,521.51,"fee schedule",null,"professional"]
["Electrocardiogram,Complet Ippe","PX-G0403","CDM","G0403","CPT",{"$nulls":8},"both",null,null,41.04,41.04,"OPTUM [1029]","VA CCN OPTUM [885]",null,13.76,null,null,13.76,13.76,13.76,"fee schedule",null,"professional"]
["Strapping Elbow/Wrist","PX-29260","CDM",29260,"CPT",{"$nulls":8},"both",null,null,83.64,83.64,"OPTUM [1029]","VA CCN OPTUM [885]",null,17.86,null,null,17.86,17.86,28.01,"fee schedule",null,"professional"]
["Menb-4c Recombnt Prot & Outer Memb Vesic Vacc Im","PX-90620","CDM",90620,"CPT",{"$nulls":8},"both",null,null,290,290,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":7},"fee schedule",null,"professional"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",{"$nulls":8},"both",null,null,654,654,"OPTUM [1029]","VA CCN OPTUM [885]",null,220.52,null,null,220.52,220.52,220.52,"fee schedule",null,"professional"]
["Incisional Biopsy Skin Ea Sep/Additional Lesion","PX-11107","CDM",11107,"CPT",{"$nulls":8},"both",null,null,205.98,205.98,"OPTUM [1029]","VA CCN OPTUM [885]",null,28.69,null,null,28.69,28.69,68.97,"fee schedule",null,"professional"]
["Injection Aa&/Strd Sciatic Nerve W/Img Gdn","PX-64445","CDM",64445,"CPT",{"$nulls":8},"both",null,null,467.58,467.58,"OPTUM [1029]","VA CCN OPTUM [885]",null,67.86,null,null,67.86,67.86,153.65,"fee schedule",null,"professional"]
["Drainage External Ear Abscess/Hematoma Simple","PX-69000","CDM",69000,"CPT",{"$nulls":8},"both",null,null,538.11,538.11,"OPTUM [1029]","VA CCN OPTUM [885]",null,120.79,null,null,120.79,120.79,180.38,"fee schedule",null,"professional"]
["Debridement Open Wound First 20 Sq Cm/<","PX-97597","CDM",97597,"CPT",{"$nulls":8},"both",null,null,294,294,"OPTUM [1029]","VA CCN OPTUM [885]",null,33.43,null,null,33.43,33.43,98.27,"fee schedule",null,"professional"]
["Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx","PX-95115","CDM",95115,"CPT",{"$nulls":8},"both",null,null,29.85,29.85,"OPTUM [1029]","VA CCN OPTUM [885]",null,9.99,null,null,9.99,9.99,9.99,"fee schedule",null,"professional"]
["Nursing Facility Dschrg Mgmt 30 Min+ Tot Time","PX-99316","CDM",99316,"CPT",{"$nulls":8},"both",null,null,372.78,372.78,"OPTUM [1029]","VA CCN OPTUM [885]",null,125.01,null,null,125.01,125.01,125.01,"fee schedule",null,"professional"]
["Periodic Preventive Med Est Patient 65yrs& Older","PX-99397","CDM",99397,"CPT",{"$nulls":8},"both",null,null,391.95,391.95,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":7},"fee schedule",null,"professional"]
["Screen Pap by Tech W MD Supv","PX-P3000","CDM","P3000","HCPCS",{"$nulls":8},"both",null,null,129.45,129.45,"OPTUM [1029]","VA CCN OPTUM [885]",null,17.76,null,null,17.76,17.76,17.76,"fee schedule",null,"professional"]
["Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm","PX-11311","CDM",11311,"CPT",{"$nulls":8},"both",null,null,396.45,396.45,"OPTUM [1029]","VA CCN OPTUM [885]",null,59.01,null,null,59.01,59.01,132.68,"fee schedule",null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm","PX-11601","CDM",11601,"CPT",{"$nulls":8},"both",null,null,661.65,661.65,"OPTUM [1029]","VA CCN OPTUM [885]",null,141.76,null,null,141.76,141.76,221.65,"fee schedule",null,"professional"]
["Repair Nail Bed","PX-11760","CDM",11760,"CPT",{"$nulls":8},"both",null,null,534.63,534.63,"OPTUM [1029]","VA CCN OPTUM [885]",null,104.72,null,null,104.72,104.72,179.05,"fee schedule",null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral","PX-64636","CDM",64636,"CPT",{"$nulls":8},"both",null,null,700.59,700.59,"OPTUM [1029]","VA CCN OPTUM [885]",null,55.24,null,null,55.24,55.24,234.02,"fee schedule",null,"professional"]
["Repair Intermediate S/a/T/E 7.6-12.5 Cm","PX-12034","CDM",12034,"CPT",{"$nulls":8},"both",null,null,964.92,964.92,"OPTUM [1029]","VA CCN OPTUM [885]",null,195.05,null,null,195.05,195.05,323.41,"fee schedule",null,"professional"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Small","PX-16020","CDM",16020,"CPT",{"$nulls":8},"both",null,null,247.14,247.14,"OPTUM [1029]","VA CCN OPTUM [885]",null,53.11,null,null,53.11,53.11,82.91,"fee schedule",null,"professional"]
["Behav Assmt W/Score & Docd/Stand Instrument","PX-96127","CDM",96127,"CPT",{"$nulls":8},"both",null,null,13.14,13.14,"OPTUM [1029]","VA CCN OPTUM [885]",null,4.43,null,null,4.43,4.43,4.43,"fee schedule",null,"professional"]
["Excision Ganglion Wrist Dorsal/Volar Primary","PX-25111","CDM",25111,"CPT",{"$nulls":8},"both",null,null,944.97,944.97,"OPTUM [1029]","VA CCN OPTUM [885]",null,318,null,null,318,318,318,"fee schedule",null,"professional"]
["Cltx Phlngl Fx Prox/Middle Px/F/T W/Manj Ea","PX-26725","CDM",26725,"CPT",{"$nulls":8},"both",null,null,1010.19,1010.19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,707.13,301.14,339.78,"percent of total billed charges",null,"professional"]
["Cltx Dstl Fibular Fx Lat Malls W/Manj","PX-27788","CDM",27788,"CPT",{"$nulls":8},"both",null,null,1244.37,1244.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,871.06,376.9,419.14,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 2nd Level","PX-64491","CDM",64491,"CPT",{"$nulls":8},"both",null,null,279.54,279.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,195.68,55.73,93.72,"percent of total billed charges",null,"professional"]
["PR Marcaine .5%","PX-J3490.25","CDM","J3490","HCPCS",{"$nulls":8},"both",null,null,0.39,0.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,0.27,null,null,"percent of total billed charges",null,"professional"]
["Colsc Flx With Directed Submucosal Njx Any Sbst","PX-45381","CDM",45381,"CPT",{"$nulls":8},"both",null,null,1275.84,1275.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,893.09,186.56,427.23,"percent of total billed charges",null,"professional"]
["Rpr Small Omphalocele W/Primary Closure","PX-49600","CDM",49600,"CPT",{"$nulls":8},"both",null,null,1999.11,1999.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1399.38,679.45,679.45,"percent of total billed charges",null,"professional"]
["Dstrj Neurolytic Agent Other Peripheral Nerve","PX-64640","CDM",64640,"CPT",{"$nulls":8},"both",null,null,720.06,720.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,504.04,113.25,240.95,"percent of total billed charges",null,"professional"]
["Im Adm Prq ID Subq/Im Njxs 1 Vaccine","PX-90471","CDM",90471,"CPT",{"$nulls":8},"both",null,null,60.3,60.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,42.21,20.14,20.14,"percent of total billed charges",null,"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only","PX-93017","CDM",93017,"CPT",{"$nulls":8},"both",null,null,109.8,109.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,76.86,36.68,36.68,"percent of total billed charges",null,"professional"]
["Office/Outpatient New High Mdm 60 Minutes","PX-99205","CDM",99205,"CPT",{"$nulls":8},"both",null,null,630.27,630.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,441.19,171.6,211.55,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Patient 65yrs&>","PX-99387","CDM",99387,"CPT",{"$nulls":8},"both",null,null,475.44,475.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,332.81,null,null,"percent of total billed charges",null,"professional"]
["Ondansetron Hcl Injection","PX-J2405","CDM","J2405","HCPCS",{"$nulls":8},"both",null,null,0.3,0.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,0.21,0.09,0.09,"percent of total billed charges",null,"professional"]
["Incision & Removal Foreign Body Subq Tiss Simple","PX-10120","CDM",10120,"CPT",{"$nulls":8},"both",null,null,441.78,441.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,309.25,102.08,147.92,"percent of total billed charges",null,"professional"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm","PX-11301","CDM",11301,"CPT",{"$nulls":8},"both",null,null,352.47,352.47,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,246.73,48.19,117.93,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G > 4.0cm","PX-11426","CDM",11426,"CPT",{"$nulls":8},"both",null,null,933.27,933.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,653.29,253.95,313.88,"percent of total billed charges",null,"professional"]
["Excision Pilonidal Cyst/Sinus Extensive","PX-11771","CDM",11771,"CPT",{"$nulls":8},"both",null,null,1781.43,1781.43,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1247,423.83,600,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E 2.6-7.5 Cm","PX-12032","CDM",12032,"CPT",{"$nulls":8},"both",null,null,880.23,880.23,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,616.16,182.06,294.7,"percent of total billed charges",null,"professional"]
["Repair Complex Eyelid/Nose/Ear/Lip 1.1-2.5 Cm","PX-13151","CDM",13151,"CPT",{"$nulls":8},"both",null,null,1213.8,1213.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,849.66,262.58,406.98,"percent of total billed charges",null,"professional"]
["Blepharoplasty Lower Eyelid","PX-15820","CDM",15820,"CPT",{"$nulls":8},"both",null,null,1683.42,1683.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1178.39,499.13,563.31,"percent of total billed charges",null,"professional"]
["Injection Single/Mlt Trigger Point 1/2 Muscles","PX-20552","CDM",20552,"CPT",{"$nulls":8},"both",null,null,150.36,150.36,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,105.25,34.75,50.47,"percent of total billed charges",null,"professional"]
["Cltx Post Hip Arthrp Dislc W/O Anes","PX-27265","CDM",27265,"CPT",{"$nulls":8},"both",null,null,1199.82,1199.82,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},404.85,404.85,null,null,"professional"]
["Psychiatric Diagnostic Evaluation","PX-90791","CDM",90791,"CPT",{"$nulls":8},"both",null,null,501.78,501.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":4},337.51,125.78,143.48,null,null,"professional"]
["Application Short Leg Cast Below Knee-Toe","PX-29405","CDM",29405,"CPT",{"$nulls":8},"both",null,null,233.76,233.76,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},55.9,78.49,null,null,"professional"]
["Injections Sclerosant for Spider Veins Lim/Trnk","PX-36468","CDM",36468,"CPT",{"$nulls":8},"both",null,null,330.78,330.78,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":9},"professional"]
["Colectomy Partial W/Anastomosis","PX-44140","CDM",44140,"CPT",{"$nulls":8},"both",null,null,3622.2,3622.2,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},1231.05,1231.05,null,null,"professional"]
["Insj Non-Ndwellg Bladder Catheter","PX-51701","CDM",51701,"CPT",{"$nulls":8},"both",null,null,127.38,127.38,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},23.78,42.77,null,null,"professional"]
["Perq Replacement Gtube Req Revj Gstrst Trc","PX-43763","CDM",43763,"CPT",{"$nulls":8},"both",null,null,965.94,965.94,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},81.19,323.17,null,null,"professional"]
["Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level","PX-64483","CDM",64483,"CPT",{"$nulls":8},"both",null,null,715.98,715.98,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},105.86,239.46,null,null,"professional"]
["Removal Impacted Cerumen Instrumentation Unilat","PX-69210","CDM",69210,"CPT",{"$nulls":8},"both",null,null,136.59,136.59,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},30.5,45.89,null,null,"professional"]
["Office/Outpatient New High Mdm 60 Minutes","PX-99205","CDM",99205,"CPT",{"$nulls":8},"both",null,null,630.27,630.27,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":4},211.66,171.6,211.55,null,null,"professional"]
["Emergency Department Visit High Mdm","PX-99285","CDM",99285,"CPT",{"$nulls":8},"both",null,null,485.31,485.31,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},163.63,163.63,null,null,"professional"]
["Home/Res Visit Est Patient Mod Mdm 40 Minutes","PX-99349","CDM",99349,"CPT",{"$nulls":8},"both",null,null,362.58,362.58,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},121.57,121.57,null,null,"professional"]
["Colon Ca Scrn Not Hi Rsk Ind","PX-G0121","CDM","G0121","HCPCS",{"$nulls":8},"both",null,null,975.87,975.87,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},171.98,327.19,null,null,"professional"]
["Tobacco Use Cessation Intensive >10 Minutes","PX-99407","CDM",99407,"CPT",{"$nulls":8},"both",null,null,78.12,78.12,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},23.6,26.22,null,null,"professional"]
["Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/<","PX-11310","CDM",11310,"CPT",{"$nulls":8},"both",null,null,336.39,336.39,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},42.78,112.53,null,null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 0.6-1.0 Cm","PX-11621","CDM",11621,"CPT",{"$nulls":8},"both",null,null,666,666,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},142.25,222.15,null,null,"professional"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 12.6-20.0cm","PX-12005","CDM",12005,"CPT",{"$nulls":8},"both",null,null,500.28,500.28,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},86.34,168.53,null,null,"professional"]
["Repair Complex Trunk 1.1-2.5 Cm","PX-13100","CDM",13100,"CPT",{"$nulls":8},"both",null,null,981.84,981.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},189.8,328.96,null,null,"professional"]
["Behavior counsel obesity 15m","PX-G0447","CDM","G0447","HCPCS",{"$nulls":8},"both",null,null,72.84,72.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},21.46,24.41,null,null,"professional"]
["Destruction Benign Lesions 15/>","PX-17111","CDM",17111,"CPT",{"$nulls":8},"both",null,null,387.84,387.84,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},80.61,129.72,null,null,"professional"]
["Cltx Greater Humeral Tuberosity Fx W/O Mnpj","PX-23620","CDM",23620,"CPT",{"$nulls":8},"both",null,null,805.62,805.62,"LABOR CARE [46]","LABOR CARE [573]",{"$nulls":5},258.96,270.75,null,null,"professional"]
["Exc Lesion Tdn Shth/Jt Capsl Hand/Fngr","PX-26160","CDM",26160,"CPT",{"$nulls":8},"both",null,null,1785.84,1785.84,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",1135.33,308.17,598.29,"other","NonFacility","professional"]
["PR Dot Physical","PX-99499.01","CDM",99499,"CPT",{"$nulls":8},"both",null,null,105,105,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",94.5,null,null,"other","Nonfacility Midlevel","professional"]
["Application Short Leg Splint Calf Foot","PX-29515","CDM",29515,"CPT",{"$nulls":8},"both",null,null,210.42,210.42,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",130.67,47.38,70.62,"other","NonFacility","professional"]
["Removal Foreign Body Intranasal Office Procedure","PX-30300","CDM",30300,"CPT",{"$nulls":8},"both",null,null,613.08,613.08,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",387.16,119.28,205.07,"other","NonFacility","professional"]
["Esophagogastroduodenoscopy Transoral Diagnostic","PX-43235","CDM",43235,"CPT",{"$nulls":8},"both",null,null,831.96,831.96,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",526.34,114.75,278.47,"other","NonFacility","professional"]
["Laparoscopy Surg Cholecystectomy","PX-47562","CDM",47562,"CPT",{"$nulls":8},"both",null,null,1796.52,1796.52,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",1200.97,610.51,610.51,"other","NonFacility","professional"]
["Fit&Insj Pessary/Oth Intravaginal Support Devi","PX-57160","CDM",57160,"CPT",{"$nulls":8},"both",null,null,211.53,211.53,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",136.15,42.65,71.13,"other","NonFacility","professional"]
["Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img","PX-64451","CDM",64451,"CPT",{"$nulls":8},"both",null,null,663.42,663.42,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",414.5,77.35,221.76,"other","NonFacility","professional"]
["Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn","PX-94060","CDM",94060,"CPT",{"$nulls":8},"both",null,null,113.73,113.73,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",69.89,9.67,37.99,"other","NonFacility","professional"]
["1st Hospital IP/Obs Care High Mdm 75 Minutes","PX-99223","CDM",99223,"CPT",{"$nulls":8},"both",null,null,489.12,489.12,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",311.79,164.19,164.19,"other","NonFacility","professional"]
["Home/Res Visit New Patient High Mdm 75 Minutes","PX-99345","CDM",99345,"CPT",{"$nulls":8},"both",null,null,575.19,575.19,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",363.45,192.84,192.84,"other","NonFacility","professional"]
["Initial Preventive Medicine New Patient 65yrs&>","PX-99387","CDM",99387,"CPT",{"$nulls":8},"both",null,null,475.44,475.44,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",291.73,null,null,"other","NonFacility","professional"]
["Ondansetron Hcl Injection","PX-J2405","CDM","J2405","HCPCS",{"$nulls":8},"both",null,null,0.3,0.3,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",0.07,0.09,0.09,"other","NonFacility","professional"]
["Incision & Removal Foreign Body Subq Tiss Simple","PX-10120","CDM",10120,"CPT",{"$nulls":8},"both",null,null,441.78,441.78,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",275.93,102.08,147.92,"other","NonFacility","professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M 0.5cm/<","PX-11440","CDM",11440,"CPT",{"$nulls":8},"both",null,null,418.68,418.68,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",261.95,104.35,140.04,"other","NonFacility","professional"]
["Excision Malignant Lesion F/E/E/N/L 3.1-4.0 Cm","PX-11644","CDM",11644,"CPT",{"$nulls":8},"both",null,null,1111.68,1111.68,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",707.46,265.57,373.3,"other","NonFacility","professional"]
["Excision Pilonidal Cyst/Sinus Extensive","PX-11771","CDM",11771,"CPT",{"$nulls":8},"both",null,null,1781.43,1781.43,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",1151.13,423.83,600,"other","NonFacility","professional"]
["Repair Intermediate S/a/T/E 2.6-7.5 Cm","PX-12032","CDM",12032,"CPT",{"$nulls":8},"both",null,null,880.23,880.23,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",554.9,182.06,294.7,"other","NonFacility","professional"]
["Repair Complex Eyelid/Nose/Ear/Lip 1.1-2.5 Cm","PX-13151","CDM",13151,"CPT",{"$nulls":8},"both",null,null,1213.8,1213.8,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",773.7,262.58,406.98,"other","NonFacility","professional"]
["Destruction Premalignant Lesion 2-14 Ea","PX-17003","CDM",17003,"CPT",{"$nulls":8},"both",null,null,19.65,19.65,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",8.6,1.96,5.57,"other","Nonfacility Midlevel","professional"]
["Cltx Humeral Shft Fx W/Manj W/WO Skeletal Tracj","PX-24505","CDM",24505,"CPT",{"$nulls":8},"both",null,null,1473.66,1473.66,"BCBS OF MN [200]","MINNESOTA ADVANTAGE HEALTH PLAN HMO [730]",{"$nulls":3},"Minimum of percent of billed and fee schedule amou",937.8,441.53,496.21,"other","NonFacility","professional"]
["Cltx Carpo/Metacarpal Dislocation Thumb W/Manj","PX-26641","CDM",26641,"CPT",{"$nulls":8},"both",null,null,1233.66,1233.66,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},376.71,415.35,null,null,"professional"]
["Cltx Prox Fibula/Shft Fx W/O Manj","PX-27780","CDM",27780,"CPT",{"$nulls":8},"both",null,null,919.08,919.08,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},283.54,308.75,null,null,"professional"]
["Transj Care Mgmt High Mdm F2f 7 Cal D Discharge","PX-99496","CDM",99496,"CPT",{"$nulls":8},"both",null,null,825.15,825.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},181.21,271.26,null,null,"professional"]
["Removal Foreign Body Foot Subcutaneous","PX-28190","CDM",28190,"CPT",{"$nulls":8},"both",null,null,697.11,697.11,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},127.81,233.25,null,null,"professional"]
["Application Cast Elbow Finger Short Arm","PX-29075","CDM",29075,"CPT",{"$nulls":8},"both",null,null,255.15,255.15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},59.51,85.71,null,null,"professional"]
["Removal/Bivalving Full Arm/Full Leg Cast","PX-29705","CDM",29705,"CPT",{"$nulls":8},"both",null,null,181.32,181.32,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},41.65,60.97,null,null,"professional"]
["Injections Sclerosant for Spider Veins Lim/Trnk","PX-36468","CDM",36468,"CPT",{"$nulls":8},"both",null,null,330.78,330.78,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"professional"]
["Exc Lesion Tongue W/Clsr Anterior Two-Thirds","PX-41112","CDM",41112,"CPT",{"$nulls":8},"both",null,null,981.09,981.09,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},234.32,328.62,null,null,"professional"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",{"$nulls":8},"both",null,null,654,654,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},220.52,220.52,null,null,"professional"]
["Colonoscopy Flx Dx W/Collj Spec When Pfrmd","PX-45378","CDM",45378,"CPT",{"$nulls":8},"both",null,null,975.48,975.48,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},171.81,327.02,null,null,"professional"]
["Rpr Recrt Inguinal Hernia Any Age Reducible","PX-49520","CDM",49520,"CPT",{"$nulls":8},"both",null,null,1726.59,1726.59,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},586.71,586.71,null,null,"professional"]
["Tangential Biopsy Skin Single Lesion","PX-11102","CDM",11102,"CPT",{"$nulls":8},"both",null,null,292.41,292.41,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},35.57,97.78,null,null,"professional"]
["Diagnostic Lumbar Spinal Puncture","PX-62270","CDM",62270,"CPT",{"$nulls":8},"both",null,null,414.84,414.84,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},57.94,139.48,null,null,"professional"]
["Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level","PX-64483","CDM",64483,"CPT",{"$nulls":8},"both",null,null,715.98,715.98,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},105.86,239.46,null,null,"professional"]
["Injection Anes Lmbr/Thrc Paravertbrl Sympathetic","PX-64520","CDM",64520,"CPT",{"$nulls":8},"both",null,null,671.88,671.88,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},81.11,224.53,null,null,"professional"]
["Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen","PX-88142","CDM",88142,"CPT",{"$nulls":8},"both",null,null,60.78,60.78,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},20.26,20.26,null,null,"professional"]
["Tdap Vaccine 7 Yrs/> Im","PX-90715","CDM",90715,"CPT",{"$nulls":8},"both",null,null,114.9,114.9,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},38.52,38.52,null,null,"professional"]
["Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn","PX-94060","CDM",94060,"CPT",{"$nulls":8},"both",null,null,113.73,113.73,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},9.67,37.99,null,null,"professional"]
["Office/Outpatient New High Mdm 60 Minutes","PX-99205","CDM",99205,"CPT",{"$nulls":8},"both",null,null,630.27,630.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},171.6,211.55,null,null,"professional"]
["IP/Obs Consltj New/Est Pt Sf Mdm 35 Minutes","PX-99252","CDM",99252,"CPT",{"$nulls":8},"both",null,null,207.27,207.27,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"professional"]
["Home/Res Visit New Patient Low Mdm 30 Minutes","PX-99342","CDM",99342,"CPT",{"$nulls":8},"both",null,null,224.04,224.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},75.03,75.03,null,null,"professional"]
["Initial Preventive Medicine New Pt Age 18-39yrs","PX-99385","CDM",99385,"CPT",{"$nulls":8},"both",null,null,380.16,380.16,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":9},"professional"]
["Periodic Preventive Med Est Patient 12-17yrs","PX-99394","CDM",99394,"CPT",{"$nulls":8},"both",null,null,334.97,334.97,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":9},"professional"]
["Ldct Eligibility Visit","PX-G0296","CDM","G0296","HCPCS",{"$nulls":8},"both",null,null,79.71,79.71,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},24.08,26.7,null,null,"professional"]
["Tobacco Use Cessation Intermediate 3-10 Minutes","PX-99406","CDM",99406,"CPT",{"$nulls":8},"both",null,null,42.82,42.82,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},11.14,14.09,null,null,"professional"]
["Incision & Drainage Abscess Complicated/Multiple","PX-10061","CDM",10061,"CPT",{"$nulls":8},"both",null,null,751.14,751.14,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},177,206.79,null,null,"professional"]
["Rmvl Skin Tags Mlt Fibrq Tags Any Ea Addl 10","PX-11201","CDM",11201,"CPT",{"$nulls":8},"both",null,null,52.2,52.2,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},15.24,17.53,null,null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm","PX-11306","CDM",11306,"CPT",{"$nulls":8},"both",null,null,356.04,356.04,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},46.06,119.08,null,null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 3.1-4.0 Cm","PX-11404","CDM",11404,"CPT",{"$nulls":8},"both",null,null,643.8,643.8,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},157.2,216.14,null,null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm","PX-11603","CDM",11603,"CPT",{"$nulls":8},"both",null,null,803.52,803.52,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},183.56,269.35,null,null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 1.1-2.0 Cm","PX-11642","CDM",11642,"CPT",{"$nulls":8},"both",null,null,773.07,773.07,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},173.08,259.2,null,null,"professional"]
["Excision Pilonidal Cyst/Sinus Simple","PX-11770","CDM",11770,"CPT",{"$nulls":8},"both",null,null,1011.72,1011.72,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},173.88,339.89,null,null,"professional"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 20.1-30.0cm","PX-12006","CDM",12006,"CPT",{"$nulls":8},"both",null,null,576.57,576.57,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},105.86,194.27,null,null,"professional"]
["Repair Intermediate S/a/T/E >30.0 Cm","PX-12037","CDM",12037,"CPT",{"$nulls":8},"both",null,null,1375.74,1375.74,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},305.44,463.27,null,null,"professional"]
["Repair Complex Trunk 2.6-7.5 Cm","PX-13101","CDM",13101,"CPT",{"$nulls":8},"both",null,null,1144.44,1144.44,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},234.35,383.34,null,null,"professional"]
["Repair Complex F/C/C/M/N/Ax/G/H/F 2.6-7.5 Cm","PX-13132","CDM",13132,"CPT",{"$nulls":8},"both",null,null,1353.66,1353.66,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},286,453.65,null,null,"professional"]
["Penicillin g benzathine inj","PX-J0561","CDM","J0561","HCPCS",{"$nulls":8},"both",null,null,15,15,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},24.37,24.37,null,null,"professional"]
["Exploration Penetrating Wound Spx Extremity","PX-20103","CDM",20103,"CPT",{"$nulls":8},"both",null,null,1603.5,1603.5,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},323.59,539.05,null,null,"professional"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O US","PX-20610","CDM",20610,"CPT",{"$nulls":8},"both",null,null,184.65,184.65,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},42.48,62.12,null,null,"professional"]
["Clsd Tx Shoulder Dislc W/Manipulation W/O Anes","PX-23650","CDM",23650,"CPT",{"$nulls":8},"both",null,null,978.72,978.72,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [270]",{"$nulls":5},296.25,329.65,null,null,"professional"]
["Continuous Glucose Monitoring Analysis I&R","PX-95251","CDM",95251,"CPT",{"$nulls":8},"both",null,null,98.76,98.76,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},33.09,33.09,null,null,"professional"]
["Closed Tx Radial&Ulnar Shaft Fractures W/O Mnpj","PX-25560","CDM",25560,"CPT",{"$nulls":8},"both",null,null,865.89,865.89,"VETERANS ADMINISTRATION [501]","VETERANS ADMINISTRATION [271]",{"$nulls":5},258.8,290.89,null,null,"professional"]
["Cltx Trimalleolar Ankle Fx W/Manipulation","PX-27818","CDM",27818,"CPT",{"$nulls":8},"both",null,null,1432.92,1432.92,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},427.8,482.81,null,null,"professional"]
["Application Finger Splint Static","PX-29130","CDM",29130,"CPT",{"$nulls":8},"both",null,null,120.27,120.27,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},27.06,40.49,null,null,"professional"]
["Intubation Endotracheal Emergency Procedure","PX-31500","CDM",31500,"CPT",{"$nulls":8},"both",null,null,383.52,383.52,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},129.74,129.74,null,null,"professional"]
["Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq","PX-45385","CDM",45385,"CPT",{"$nulls":8},"both",null,null,1301.97,1301.97,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},236.4,436.46,null,null,"professional"]
["Incisional Biopsy Skin Ea Sep/Additional Lesion","PX-11107","CDM",11107,"CPT",{"$nulls":8},"both",null,null,205.98,205.98,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},28.69,68.97,null,null,"professional"]
["Injection Aa&/Strd Sciatic Nerve W/Img Gdn","PX-64445","CDM",64445,"CPT",{"$nulls":8},"both",null,null,467.58,467.58,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},67.86,153.65,null,null,"professional"]
["Removal FB Eye Conjunctival Superficial","PX-65205","CDM",65205,"CPT",{"$nulls":8},"both",null,null,81.99,81.99,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},27.36,27.69,null,null,"professional"]
["Im Adm Prq ID Subq/Im Njxs Ea Vaccine","PX-90472","CDM",90472,"CPT",{"$nulls":8},"both",null,null,42.63,42.63,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},14.25,14.25,null,null,"professional"]
["Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min","PX-99234","CDM",99234,"CPT",{"$nulls":8},"both",null,null,274.56,274.56,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},92.27,92.27,null,null,"professional"]
["Home/Res Visit Est Patient Sf Mdm 20 Minutes","PX-99347","CDM",99347,"CPT",{"$nulls":8},"both",null,null,129.57,129.57,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},43.41,43.41,null,null,"professional"]
["Prostate Ca Screening; Dre","PX-G0102","CDM","G0102","HCPCS",{"$nulls":8},"both",null,null,68.16,68.16,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},8.36,22.76,null,null,"professional"]
["Promethazine Hcl Injection","PX-J2550","CDM","J2550","HCPCS",{"$nulls":8},"both",null,null,10.8,10.8,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},3.31,3.31,null,null,"professional"]
["Incision & Removal Foreign Body Subq Tiss Comp","PX-10121","CDM",10121,"CPT",{"$nulls":8},"both",null,null,758.64,758.64,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},174.42,254.65,null,null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm","PX-11401","CDM",11401,"CPT",{"$nulls":8},"both",null,null,452.97,452.97,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},101.92,151.69,null,null,"professional"]
["Excision Malignant Lesion F/E/E/N/L >4.0 Cm","PX-11646","CDM",11646,"CPT",{"$nulls":8},"both",null,null,1430.1,1430.1,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},364.5,481.07,null,null,"professional"]
["Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm","PX-12002","CDM",12002,"CPT",{"$nulls":8},"both",null,null,324.57,324.57,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},54.15,109.16,null,null,"professional"]
["Repair Complx Eyelid/Nose/Ear/Lip Ea Addl 5 Cm/<","PX-13153","CDM",13153,"CPT",{"$nulls":8},"both",null,null,521.76,521.76,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},126.76,175.55,null,null,"professional"]
["Destruction Benign Lesions Up to 14","PX-17110","CDM",17110,"CPT",{"$nulls":8},"both",null,null,332.7,332.7,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},66.67,94.53,null,null,"professional"]
["Cltx Prox Humrl Fx W/Mnpj W/WO Skeletal Tracj","PX-23605","CDM",23605,"CPT",{"$nulls":8},"both",null,null,1372.41,1372.41,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},417.58,462.11,null,null,"professional"]
["Treatment Closed Elbow Dislocation Req Anes","PX-24605","CDM",24605,"CPT",{"$nulls":8},"both",null,null,1377.54,1377.54,"HEALTH ADMIN CENTER [505]","CHAMPVA [309]",{"$nulls":5},464.3,464.3,null,null,"professional"]
["Removal Foreign Body Deep Thigh/Knee","PX-27372","CDM",27372,"CPT",{"$nulls":8},"both",null,null,1674.27,1674.27,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},381.6,563,null,null,"professional"]
["Cltx Tarsal Dislc Oth/Thn Talotarsal W/O Anes","PX-28540","CDM",28540,"CPT",{"$nulls":8},"both",null,null,583.98,583.98,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},175.11,195.41,null,null,"professional"]
["Myocardial Spect Multiple Studies|PROFESSIONAL COMPONENT","PX-78452","CDM",78452,"CPT",{"$nulls":8},"both",null,null,1267.53,1267.53,"UMR [623]","UMR LABORCARE [152]",26,{"$nulls":4},72.07,72.07,null,null,"professional"]
["Drg Absc Cst Hmtma From Dentoalveolar Struxs","PX-41800","CDM",41800,"CPT",{"$nulls":8},"both",null,null,847.17,847.17,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},149.11,283.36,null,null,"professional"]
["Colectomy Prtl W/Coloproctostomy","PX-44145","CDM",44145,"CPT",{"$nulls":8},"both",null,null,4462.86,4462.86,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},1514.72,1514.72,null,null,"professional"]
["Insj Temp Ndwellg Bladder Catheter Simple","PX-51702","CDM",51702,"CPT",{"$nulls":8},"both",null,null,180.06,180.06,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},23.61,60.28,null,null,"professional"]
["Therapeutic Spinal Puncture Drainage CSF","PX-62272","CDM",62272,"CPT",{"$nulls":8},"both",null,null,518.25,518.25,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},82.77,174.78,null,null,"professional"]
["Dis site tele svcs rhc/fqhc","PX-G2025","CDM","G2025","HCPCS",{"$nulls":8},"both",null,null,285.81,285.81,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"professional"]
["Vital Capacity Total Separate Procedure","PX-94150","CDM",94150,"CPT",{"$nulls":8},"both",null,null,74.66,74.66,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"professional"]
["Office/Outpatient Est Pt May Not Req Phys/Qhp","PX-99211","CDM",99211,"CPT",{"$nulls":8},"both",null,null,68.16,68.16,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},8.36,22.76,null,null,"professional"]
["Periodic Preventive Med Est Patient 18-39 Yrs","PX-99395","CDM",99395,"CPT",{"$nulls":8},"both",null,null,342.83,342.83,"UMR [623]","UMR LABORCARE [152]",{"$nulls":4},146.72,{"$nulls":4},"professional"]
["Intraut Copper Contraceptive","PX-J7300","CDM","J7300","HCPCS",{"$nulls":8},"both",null,null,436,436,"UMR [623]","UMR LABORCARE [152]",{"$nulls":9},"professional"]
["Phys/Qhp Telephone Evaluation 11-20 Min","PX-99442","CDM",99442,"CPT",{"$nulls":8},"both",null,null,261.72,261.72,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},62.43,74.49,null,null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm","PX-11307","CDM",11307,"CPT",{"$nulls":8},"both",null,null,401.37,401.37,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},58.68,134.32,null,null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 1.1-2.0 Cm","PX-11622","CDM",11622,"CPT",{"$nulls":8},"both",null,null,731.91,731.91,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},161.43,245.25,null,null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora","PX-64633","CDM",64633,"CPT",{"$nulls":8},"both",null,null,5858.31,5858.31,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},182.89,425.53,null,null,"professional"]
["Repair Intermediate S/a/T/E >30.0 Cm","PX-12037","CDM",12037,"CPT",{"$nulls":8},"both",null,null,1375.74,1375.74,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},305.44,463.27,null,null,"professional"]
["Repair Complex Trunk 2.6-7.5 Cm","PX-13101","CDM",13101,"CPT",{"$nulls":8},"both",null,null,1144.44,1144.44,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},234.35,383.34,null,null,"professional"]
["Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US","PX-20606","CDM",20606,"CPT",{"$nulls":8},"both",null,null,258.33,258.33,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},48.7,86.68,null,null,"professional"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O US","PX-20610","CDM",20610,"CPT",{"$nulls":8},"both",null,null,184.65,184.65,"UMR [623]","UMR LABORCARE [152]",{"$nulls":5},42.48,62.12,null,null,"professional"]
["Cltx Carpo/Metacarpal Dislocation Thumb W/Manj","PX-26641","CDM",26641,"CPT",{"$nulls":8},"both",null,null,1233.66,1233.66,"OPTUM [1029]","VA CCN OPTUM [885]",null,415.35,null,null,415.35,376.71,415.35,"fee schedule",null,"professional"]
["Psychotherapy W/Patient 60 Minutes","PX-90837","CDM",90837,"CPT",{"$nulls":8},"both",null,null,443.46,443.46,"OPTUM [1029]","VA CCN OPTUM [885]",null,111.17,null,null,111.17,111.17,129.55,"fee schedule",null,"professional"]
["Initial Nursing Facility Care Hi Mdm 50 Minutes","PX-99306","CDM",99306,"CPT",{"$nulls":8},"both",null,null,518.46,518.46,"OPTUM [1029]","VA CCN OPTUM [885]",null,173.84,null,null,173.84,173.84,173.84,"fee schedule",null,"professional"]
["Strapping Unna Boot","PX-29580","CDM",29580,"CPT",{"$nulls":8},"both",null,null,184.35,184.35,"OPTUM [1029]","VA CCN OPTUM [885]",null,61.76,null,null,61.76,24.43,61.76,"fee schedule",null,"professional"]
["Colonoscopy Flx Dx W/Collj Spec When Pfrmd","PX-45378","CDM",45378,"CPT",{"$nulls":8},"both",null,null,975.48,975.48,"OPTUM [1029]","VA CCN OPTUM [885]",null,327.02,null,null,327.02,171.81,327.02,"fee schedule",null,"professional"]
["Rpr Recrt Inguinal Hernia Any Age Reducible","PX-49520","CDM",49520,"CPT",{"$nulls":8},"both",null,null,1726.59,1726.59,"OPTUM [1029]","VA CCN OPTUM [885]",null,586.71,null,null,586.71,586.71,586.71,"fee schedule",null,"professional"]
["Fit&Insj Pessary/Oth Intravaginal Support Devi","PX-57160","CDM",57160,"CPT",{"$nulls":8},"both",null,null,211.53,211.53,"OPTUM [1029]","VA CCN OPTUM [885]",null,71.13,null,null,71.13,42.65,71.13,"fee schedule",null,"professional"]
["Removal FB Eye Conjunctival Superficial","PX-65205","CDM",65205,"CPT",{"$nulls":8},"both",null,null,81.99,81.99,"OPTUM [1029]","VA CCN OPTUM [885]",null,27.36,null,null,27.36,27.36,27.69,"fee schedule",null,"professional"]
["Cardioversion Elective Arrhythmia External","PX-92960","CDM",92960,"CPT",{"$nulls":8},"both",null,null,441.78,441.78,"OPTUM [1029]","VA CCN OPTUM [885]",null,147.92,null,null,147.92,101.75,147.92,"fee schedule",null,"professional"]
["Office/Outpatient New Moderate Mdm 45 Minutes","PX-99204","CDM",99204,"CPT",{"$nulls":8},"both",null,null,478.56,478.56,"OPTUM [1029]","VA CCN OPTUM [885]",null,136.49,null,null,136.49,126.2,136.49,"fee schedule",null,"professional"]
["Sbsq Hospital IP/Obs Care Mod Mdm 35 Minutes","PX-99232","CDM",99232,"CPT",{"$nulls":8},"both",null,null,222.57,222.57,"OPTUM [1029]","VA CCN OPTUM [885]",null,74.72,null,null,74.72,74.72,74.72,"fee schedule",null,"professional"]
["Home/Res Visit Est Patient Low Mdm 30 Minutes","PX-99348","CDM",99348,"CPT",{"$nulls":8},"both",null,null,219.12,219.12,"OPTUM [1029]","VA CCN OPTUM [885]",null,73.39,null,null,73.39,73.39,73.39,"fee schedule",null,"professional"]
["Colorectal Scrn; Hi Risk Ind","PX-G0105","CDM","G0105","HCPCS",{"$nulls":8},"both",null,null,975.48,975.48,"OPTUM [1029]","VA CCN OPTUM [885]",null,327.02,null,null,327.02,171.81,327.02,"fee schedule",null,"professional"]
["Puncture Aspiration Abscess Hematoma Bulla/Cyst","PX-10160","CDM",10160,"CPT",{"$nulls":8},"both",null,null,374.37,374.37,"OPTUM [1029]","VA CCN OPTUM [885]",null,125.5,null,null,125.5,92.76,125.5,"fee schedule",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 2.1-3.0 Cm","PX-11403","CDM",11403,"CPT",{"$nulls":8},"both",null,null,571.05,571.05,"OPTUM [1029]","VA CCN OPTUM [885]",null,191.54,null,null,191.54,143.73,191.54,"fee schedule",null,"professional"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 1.1-2.0cm","PX-11442","CDM",11442,"CPT",{"$nulls":8},"both",null,null,559.11,559.11,"OPTUM [1029]","VA CCN OPTUM [885]",null,187.43,null,null,187.43,141.59,187.43,"fee schedule",null,"professional"]
["Trimming Nondystrophic Nails Any Number","PX-11719","CDM",11719,"CPT",{"$nulls":8},"both",null,null,41.64,41.64,"OPTUM [1029]","VA CCN OPTUM [885]",null,13.92,null,null,13.92,7.05,13.92,"fee schedule",null,"professional"]
["Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm","PX-12004","CDM",12004,"CPT",{"$nulls":8},"both",null,null,376.32,376.32,"OPTUM [1029]","VA CCN OPTUM [885]",null,126.72,null,null,126.72,67.45,126.72,"fee schedule",null,"professional"]
["Adjt Tis Trnsfr/Reargmt Scalp/Arm/Leg 10 Sq Cm/<","PX-14020","CDM",14020,"CPT",{"$nulls":8},"both",null,null,2022.72,2022.72,"OPTUM [1029]","VA CCN OPTUM [885]",null,678.88,null,null,678.88,542.01,678.88,"fee schedule",null,"professional"]
["Destruction Benign Lesions 15/>","PX-17111","CDM",17111,"CPT",{"$nulls":8},"both",null,null,387.84,387.84,"OPTUM [1029]","VA CCN OPTUM [885]",null,129.72,null,null,129.72,80.61,129.72,"fee schedule",null,"professional"]
["Aspiration&/Injection Ganglion Cyst Any Locatj","PX-20612","CDM",20612,"CPT",{"$nulls":8},"both",null,null,186.48,186.48,"OPTUM [1029]","VA CCN OPTUM [885]",null,62.6,null,null,62.6,38.69,62.6,"fee schedule",null,"professional"]
["9vhpv Vacc 2/3 Dose Sched Im Use","PX-90651","CDM",90651,"CPT",{"$nulls":8},"both",null,null,372,372,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":7},"fee schedule",null,"professional"]
["Behav Assmt W/Score & Docd/Stand Instrument","PX-96127","CDM",96127,"CPT",{"$nulls":8},"both",null,null,13.14,13.14,"OPTUM [1029]","VA CCN OPTUM [885]",null,4.43,null,null,4.43,4.43,4.43,"fee schedule",null,"professional"]
["Chronic Care Mgmt Svcs Staff 1st 20 Min Cal Mo","PX-99490","CDM",99490,"CPT",{"$nulls":8},"both",null,null,180.42,180.42,"OPTUM [1029]","VA CCN OPTUM [885]",null,60.45,null,null,60.45,47.68,60.45,"fee schedule",null,"professional"]
["Advance Care Planning First 30 Mins","PX-99497","CDM",99497,"CPT",{"$nulls":8},"both",null,null,241.65,241.65,"OPTUM [1029]","VA CCN OPTUM [885]",null,78.97,null,null,78.97,71.77,78.97,"fee schedule",null,"professional"]
["4vhpv Vaccine 3 Dose Schedule for Im Use","PX-90649","CDM",90649,"CPT",{"$nulls":8},"both",null,null,349.94,349.94,"OPTUM [1029]","VA CCN OPTUM [885]",{"$nulls":7},"fee schedule",null,"professional"]
["Td Vaccine Prsrv Free 7 Yrs or Older for Im Use","PX-90714","CDM",90714,"CPT",{"$nulls":8},"both",null,null,91.32,91.32,"OPTUM [1029]","VA CCN OPTUM [885]",null,43.66,null,null,43.66,43.66,43.66,"fee schedule",null,"professional"]
["Excision Tumor Soft Tissue Back/Flank Subq <3cm","PX-21930","CDM",21930,"CPT",{"$nulls":8},"both",null,null,1430.52,1430.52,"OPTUM [1029]","VA CCN OPTUM [885]",null,481.61,null,null,481.61,346.38,481.61,"fee schedule",null,"professional"]
["Cltx Prox Humrl Fx W/Mnpj W/WO Skeletal Tracj","PX-23605","CDM",23605,"CPT",{"$nulls":8},"both",null,null,1372.41,1372.41,"OPTUM [1029]","VA CCN OPTUM [885]",null,462.11,null,null,462.11,417.58,462.11,"fee schedule",null,"professional"]
["Cltx Greater Humeral Tuberosity Fx W/O Mnpj","PX-23620","CDM",23620,"CPT",{"$nulls":8},"both",null,null,805.62,805.62,"OPTUM [1029]","VA CCN OPTUM [885]",null,270.75,null,null,270.75,258.96,270.75,"fee schedule",null,"professional"]
["Clsd Tx Shoulder Dislc W/Manipulation W/O Anes","PX-23650","CDM",23650,"CPT",{"$nulls":8},"both",null,null,978.72,978.72,"OPTUM [1029]","VA CCN OPTUM [885]",null,329.65,null,null,329.65,296.25,329.65,"fee schedule",null,"professional"]
["Clsd Tx Shoulder Dislc W/Manipulation Req Anes","PX-23655","CDM",23655,"CPT",{"$nulls":8},"both",null,null,1178.85,1178.85,"OPTUM [1029]","VA CCN OPTUM [885]",null,397.24,null,null,397.24,397.24,397.24,"fee schedule",null,"professional"]
["Incision&Drainage Upper Arm/Elbow Bursa","PX-23931","CDM",23931,"CPT",{"$nulls":8},"both",null,null,878.55,878.55,"OPTUM [1029]","VA CCN OPTUM [885]",null,294.4,null,null,294.4,155.57,294.4,"fee schedule",null,"professional"]
["Excision Olecranon Bursa","PX-24105","CDM",24105,"CPT",{"$nulls":8},"both",null,null,1046.82,1046.82,"OPTUM [1029]","VA CCN OPTUM [885]",null,352.25,null,null,352.25,352.25,352.25,"fee schedule",null,"professional"]
["Exc/Curtg Bone Cyst/Benign Tumor H/N Rds/Olecrn","PX-24120","CDM",24120,"CPT",{"$nulls":8},"both",null,null,1520.22,1520.22,"OPTUM [1029]","VA CCN OPTUM [885]",null,512.71,null,null,512.71,512.71,512.71,"fee schedule",null,"professional"]
["Continuous Glucose Monitoring Analysis I&R","PX-95251","CDM",95251,"CPT",{"$nulls":8},"both",null,null,98.76,98.76,"OPTUM [1029]","VA CCN OPTUM [885]",null,33.09,null,null,33.09,33.09,33.09,"fee schedule",null,"professional"]
["Clsd Tx Humeral Shaft Fracture W/O Manipulation","PX-24500","CDM",24500,"CPT",{"$nulls":8},"both",null,null,1076.01,1076.01,"OPTUM [1029]","VA CCN OPTUM [885]",null,361.72,null,null,361.72,332.25,361.72,"fee schedule",null,"professional"]
["Cltx Humeral Shft Fx W/Manj W/WO Skeletal Tracj","PX-24505","CDM",24505,"CPT",{"$nulls":8},"both",null,null,1473.66,1473.66,"OPTUM [1029]","VA CCN OPTUM [885]",null,496.21,null,null,496.21,441.53,496.21,"fee schedule",null,"professional"]
["Treatment Closed Elbow Dislocation W/O Anes","PX-24600","CDM",24600,"CPT",{"$nulls":8},"both",null,null,1101.93,1101.93,"OPTUM [1029]","VA CCN OPTUM [885]",null,371.33,null,null,371.33,334.66,371.33,"fee schedule",null,"professional"]
["Treatment Closed Elbow Dislocation Req Anes","PX-24605","CDM",24605,"CPT",{"$nulls":8},"both",null,null,1377.54,1377.54,"OPTUM [1029]","VA CCN OPTUM [885]",null,464.3,null,null,464.3,464.3,464.3,"fee schedule",null,"professional"]
["Cltx Rdl Head Sublxtj Chld Nursemaid Elbw W/Manj","PX-24640","CDM",24640,"CPT",{"$nulls":8},"both",null,null,304.95,304.95,"OPTUM [1029]","VA CCN OPTUM [885]",null,102.05,null,null,102.05,77.82,102.05,"fee schedule",null,"professional"]
["Closed Tx Radial Head/Neck Fx W/O Manipulation","PX-24650","CDM",24650,"CPT",{"$nulls":8},"both",null,null,789,789,"OPTUM [1029]","VA CCN OPTUM [885]",null,264.99,null,null,264.99,246.32,264.99,"fee schedule",null,"professional"]
["Closed Tx Ulnar Fracture Proximal End W/O Manj","PX-24670","CDM",24670,"CPT",{"$nulls":8},"both",null,null,870.57,870.57,"OPTUM [1029]","VA CCN OPTUM [885]",null,292.54,null,null,292.54,266.67,292.54,"fee schedule",null,"professional"]
["Closed Tx Ulnar Fracture Proximal End W/Manj","PX-24675","CDM",24675,"CPT",{"$nulls":8},"both",null,null,1347.57,1347.57,"OPTUM [1029]","VA CCN OPTUM [885]",null,453.57,null,null,453.57,409.03,453.57,"fee schedule",null,"professional"]
["Excision Ganglion Wrist Dorsal/Volar Primary","PX-25111","CDM",25111,"CPT",{"$nulls":8},"both",null,null,944.97,944.97,"OPTUM [1029]","VA CCN OPTUM [885]",null,318,null,null,318,318,318,"fee schedule",null,"professional"]
["Closed Tx Radial Shaft Fracture W/O Manipulation","PX-25500","CDM",25500,"CPT",{"$nulls":8},"both",null,null,849.81,849.81,"OPTUM [1029]","VA CCN OPTUM [885]",null,285.48,null,null,285.48,257.65,285.48,"fee schedule",null,"professional"]
["Closed Tx Radial&Ulnar Shaft Fractures W/O Mnpj","PX-25560","CDM",25560,"CPT",{"$nulls":8},"both",null,null,865.89,865.89,"OPTUM [1029]","VA CCN OPTUM [885]",null,290.89,null,null,290.89,258.8,290.89,"fee schedule",null,"professional"]
["Cltx Dstl Radial Fx/Epiphysl Sep W/O Mnpj","PX-25600","CDM",25600,"CPT",{"$nulls":8},"both",null,null,1012.41,1012.41,"OPTUM [1029]","VA CCN OPTUM [885]",null,339.86,null,null,339.86,324.8,339.86,"fee schedule",null,"professional"]
["Cltx Dstl Rdl Fx/Epiphysl Sep W/Mnpj","PX-25605","CDM",25605,"CPT",{"$nulls":8},"both",null,null,1569.66,1569.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1098.76,497.77,528.88,"percent of total billed charges",null,"professional"]
["Closed Tx Carpal Scaphoid Fracture W/O Mnpj","PX-25622","CDM",25622,"CPT",{"$nulls":8},"both",null,null,917.73,917.73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,642.41,283.7,308.25,"percent of total billed charges",null,"professional"]
["Drainage Finger Abscess Simple","PX-26010","CDM",26010,"CPT",{"$nulls":8},"both",null,null,1001.31,1001.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,700.92,136.53,334.96,"percent of total billed charges",null,"professional"]
["Exc Lesion Tdn Shth/Jt Capsl Hand/Fngr","PX-26160","CDM",26160,"CPT",{"$nulls":8},"both",null,null,1785.84,1785.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1250.09,308.17,598.29,"percent of total billed charges",null,"professional"]
["Manipulation Finger Joint Under Anes Each Joint","PX-26340","CDM",26340,"CPT",{"$nulls":8},"both",null,null,1053.39,1053.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,737.37,353.6,353.6,"percent of total billed charges",null,"professional"]
["Cltx Carpo/Metacarpal Dislocation Thumb W/Manj","PX-26641","CDM",26641,"CPT",{"$nulls":8},"both",null,null,1233.66,1233.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,863.56,376.71,415.35,"percent of total billed charges",null,"professional"]
["Cltx Metacarpophalangeal Dislc W/Manj W/O Anes","PX-26700","CDM",26700,"CPT",{"$nulls":8},"both",null,null,999.06,999.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,699.34,308.87,336.38,"percent of total billed charges",null,"professional"]
["Cltx Phlngl Fx Prox/Middle Px/F/T W/Manj Ea","PX-26725","CDM",26725,"CPT",{"$nulls":8},"both",null,null,1010.19,1010.19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,707.13,301.14,339.78,"percent of total billed charges",null,"professional"]
["Cltx Iphal Jt Dislc W/Manj W/O Anes","PX-26770","CDM",26770,"CPT",{"$nulls":8},"both",null,null,854.31,854.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,598.02,260.33,287.51,"percent of total billed charges",null,"professional"]
["Amp F/Th 1/2 Jt/Phalanx W/Neurect W/Dir Clsr","PX-26951","CDM",26951,"CPT",{"$nulls":8},"both",null,null,2029.32,2029.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1420.52,681.75,681.75,"percent of total billed charges",null,"professional"]
["Inject Si Joint Arthrgrphy&/Anes/Steroid W/Ima","PX-27096","CDM",27096,"CPT",{"$nulls":8},"both",null,null,475.8,475.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,333.06,78.66,159.21,"percent of total billed charges",null,"professional"]
["Tx Spon Hip Dislc Abdct Splnt/Trcj W/Manj Anes","PX-27257","CDM",27257,"CPT",{"$nulls":8},"both",null,null,1004.1,1004.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,702.87,339.7,339.7,"percent of total billed charges",null,"professional"]
["Cltx Post Hip Arthrp Dislc W/O Anes","PX-27265","CDM",27265,"CPT",{"$nulls":8},"both",null,null,1199.82,1199.82,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,839.87,404.85,404.85,"percent of total billed charges",null,"professional"]
["Removal Foreign Body Deep Thigh/Knee","PX-27372","CDM",27372,"CPT",{"$nulls":8},"both",null,null,1674.27,1674.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1171.99,381.6,563,"percent of total billed charges",null,"professional"]
["Njx Aa&/Strd Plantar Common Digital Nerves","PX-64455","CDM",64455,"CPT",{"$nulls":8},"both",null,null,143.7,143.7,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,100.59,31.47,48.17,"percent of total billed charges",null,"professional"]
["Therapeutic Prophylactic/Dx Injection Subq/Im","PX-96372","CDM",96372,"CPT",{"$nulls":8},"both",null,null,41.64,41.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,29.15,11.83,13.92,"percent of total billed charges",null,"professional"]
["Closed Tx Knee Dislocation W/Anesthesia","PX-27552","CDM",27552,"CPT",{"$nulls":8},"both",null,null,1805.31,1805.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1263.72,609.15,609.15,"percent of total billed charges",null,"professional"]
["Closed Tx Patellar Dislocation W/O Anesthesia","PX-27560","CDM",27560,"CPT",{"$nulls":8},"both",null,null,1096.59,1096.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,767.61,335.43,369.16,"percent of total billed charges",null,"professional"]
["Thoracentesis Needle/Cath Pleura W/O Imaging","PX-32554","CDM",32554,"CPT",{"$nulls":8},"both",null,null,675.87,675.87,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,473.11,82.14,226.22,"percent of total billed charges",null,"professional"]
["Perq Drainage Pleura Insert Cath W/O Imaging","PX-32556","CDM",32556,"CPT",{"$nulls":8},"both",null,null,2148.48,2148.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1503.94,113.99,717.8,"percent of total billed charges",null,"professional"]
["Chemodervate Facial/Trigem/Cerv Musc Migraine","PX-64615","CDM",64615,"CPT",{"$nulls":8},"both",null,null,417.54,417.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,292.28,111.19,141.97,"percent of total billed charges",null,"professional"]
["Cltx Tibial Shaft Fx W/Manj W/WO Skel Tracj","PX-27752","CDM",27752,"CPT",{"$nulls":8},"both",null,null,1547.43,1547.43,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1083.2,474.04,521.51,"percent of total billed charges",null,"professional"]
["Cltx Prox Fibula/Shft Fx W/O Manj","PX-27780","CDM",27780,"CPT",{"$nulls":8},"both",null,null,919.08,919.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,643.36,283.54,308.75,"percent of total billed charges",null,"professional"]
["Psychiatric Diagnostic Evaluation","PX-90791","CDM",90791,"CPT",{"$nulls":8},"both",null,null,501.78,501.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,351.25,125.78,143.48,"percent of total billed charges",null,"professional"]
["Psychiatric Diagnostic Eval W/Medical Services","PX-90792","CDM",90792,"CPT",{"$nulls":8},"both",null,null,561.39,561.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,392.97,163.65,187.88,"percent of total billed charges",null,"professional"]
["Psychotherapy W/Patient 30 Minutes","PX-90832","CDM",90832,"CPT",{"$nulls":8},"both",null,null,227.82,227.82,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,159.47,57.12,66.33,"percent of total billed charges",null,"professional"]
["Psychotherapy W/Patient 45 Minutes","PX-90834","CDM",90834,"CPT",{"$nulls":8},"both",null,null,300.87,300.87,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,210.61,75.42,87.79,"percent of total billed charges",null,"professional"]
["Psychotherapy W/Patient 60 Minutes","PX-90837","CDM",90837,"CPT",{"$nulls":8},"both",null,null,443.46,443.46,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,310.42,111.17,129.55,"percent of total billed charges",null,"professional"]
["Psychotherapy for Crisis Initial 60 Minutes","PX-90839","CDM",90839,"CPT",{"$nulls":8},"both",null,null,426.15,426.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,298.31,125.14,142.49,"percent of total billed charges",null,"professional"]
["Cltx Dstl Fibular Fx Lat Malls W/Manj","PX-27788","CDM",27788,"CPT",{"$nulls":8},"both",null,null,1244.37,1244.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,871.06,376.9,419.14,"percent of total billed charges",null,"professional"]
["Closed Tx Bimalleolar Ankle Fracture W/Manj","PX-27810","CDM",27810,"CPT",{"$nulls":8},"both",null,null,1383.12,1383.12,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,968.18,417.12,465.91,"percent of total billed charges",null,"professional"]
["Cltx Trimalleolar Ankle Fx W/Manipulation","PX-27818","CDM",27818,"CPT",{"$nulls":8},"both",null,null,1432.92,1432.92,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1003.04,427.8,482.81,"percent of total billed charges",null,"professional"]
["Transj Care Mgmt Mod Mdm F2f 14 Cal D Discharge","PX-99495","CDM",99495,"CPT",{"$nulls":8},"both",null,null,610.02,610.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,427.01,133.37,170.42,"percent of total billed charges",null,"professional"]
["Transj Care Mgmt High Mdm F2f 7 Cal D Discharge","PX-99496","CDM",99496,"CPT",{"$nulls":8},"both",null,null,825.15,825.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,577.61,181.21,271.26,"percent of total billed charges",null,"professional"]
["Closed Tx Ankle Dislocation W/O Anesthesia","PX-27840","CDM",27840,"CPT",{"$nulls":8},"both",null,null,1119.9,1119.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,783.93,377.59,377.59,"percent of total billed charges",null,"professional"]
["Initial Nursing Facility Care Sf/Low Mdm 25 Min","PX-99304","CDM",99304,"CPT",{"$nulls":8},"both",null,null,228.09,228.09,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,159.66,76.52,76.52,"percent of total billed charges",null,"professional"]
["Initial Nursing Facility Care Mod Mdm 35 Minutes","PX-99305","CDM",99305,"CPT",{"$nulls":8},"both",null,null,379.65,379.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,265.76,127.31,127.31,"percent of total billed charges",null,"professional"]
["PR Dot Physical","PX-99499.01","CDM",99499,"CPT",{"$nulls":8},"both",null,null,105,105,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,73.5,null,null,"percent of total billed charges",null,"professional"]
["Initial Nursing Facility Care Hi Mdm 50 Minutes","PX-99306","CDM",99306,"CPT",{"$nulls":8},"both",null,null,518.46,518.46,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,362.92,173.84,173.84,"percent of total billed charges",null,"professional"]
["Removal Foreign Body Foot Subcutaneous","PX-28190","CDM",28190,"CPT",{"$nulls":8},"both",null,null,697.11,697.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,487.98,127.81,233.25,"percent of total billed charges",null,"professional"]
["PR Sports Physical Clinic","PX-9000003","CDM",{"$nulls":10},"both",null,null,51.63,51.63,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,36.14,null,null,"percent of total billed charges",null,"professional"]
["Sbsq Nursing Facility Care Sf Mdm 10 Minutes","PX-99307","CDM",99307,"CPT",{"$nulls":8},"both",null,null,114.84,114.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,80.39,38.5,38.5,"percent of total billed charges",null,"professional"]
["PR Ippe","PX-G0402","CDM","G0402","HCPCS",{"$nulls":8},"both",null,null,489.2,489.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,342.44,125.01,160.38,"percent of total billed charges",null,"professional"]
["Electrocardiogram,Complet Ippe","PX-G0403","CDM","G0403","CPT",{"$nulls":8},"both",null,null,41.04,41.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,28.73,13.76,13.76,"percent of total billed charges",null,"professional"]
["Sbsq Nursing Facility Care Low Mdm 20 Minutes","PX-99308","CDM",99308,"CPT",{"$nulls":8},"both",null,null,212.61,212.61,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,148.83,60.58,71.27,"percent of total billed charges",null,"professional"]
["Sbsq Nursing Facility Care Mod Mdm 30 Minutes","PX-99309","CDM",99309,"CPT",{"$nulls":8},"both",null,null,307.44,307.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,215.21,87.59,103.05,"percent of total billed charges",null,"professional"]
["Sbsq Nursing Facility Care High Mdm 45 Minutes","PX-99310","CDM",99310,"CPT",{"$nulls":8},"both",null,null,437.76,437.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,306.43,146.81,146.81,"percent of total billed charges",null,"professional"]
["Cltx Tarsal Dislc Oth/Thn Talotarsal W/O Anes","PX-28540","CDM",28540,"CPT",{"$nulls":8},"both",null,null,583.98,583.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,408.79,175.11,195.41,"percent of total billed charges",null,"professional"]
["Cltx Metatarsophlngl Jt Dislc W/O Anes","PX-28630","CDM",28630,"CPT",{"$nulls":8},"both",null,null,448.26,448.26,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,313.78,106.08,150.61,"percent of total billed charges",null,"professional"]
["Application Cast Shoulder Hand Long Arm","PX-29065","CDM",29065,"CPT",{"$nulls":8},"both",null,null,282.42,282.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,197.69,64.76,94.89,"percent of total billed charges",null,"professional"]
["Application Cast Elbow Finger Short Arm","PX-29075","CDM",29075,"CPT",{"$nulls":8},"both",null,null,255.15,255.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,178.61,59.51,85.71,"percent of total billed charges",null,"professional"]
["Application Long Arm Splint Shoulder Hand","PX-29105","CDM",29105,"CPT",{"$nulls":8},"both",null,null,239.79,239.79,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,167.85,38.4,80.64,"percent of total billed charges",null,"professional"]
["Application Short Arm Splint Forearm-Hand Static","PX-29125","CDM",29125,"CPT",{"$nulls":8},"both",null,null,195.9,195.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,137.13,38.52,65.7,"percent of total billed charges",null,"professional"]
["Application Finger Splint Static","PX-29130","CDM",29130,"CPT",{"$nulls":8},"both",null,null,120.27,120.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,84.19,27.06,40.49,"percent of total billed charges",null,"professional"]
["Strapping Elbow/Wrist","PX-29260","CDM",29260,"CPT",{"$nulls":8},"both",null,null,83.64,83.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,58.55,17.86,28.01,"percent of total billed charges",null,"professional"]
["Strapping Hand/Finger","PX-29280","CDM",29280,"CPT",{"$nulls":8},"both",null,null,85.38,85.38,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,59.77,18.86,28.68,"percent of total billed charges",null,"professional"]
["Application Long Leg Cast Thigh-Toe","PX-29345","CDM",29345,"CPT",{"$nulls":8},"both",null,null,389.91,389.91,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,272.94,93.47,131.12,"percent of total billed charges",null,"professional"]
["Application Short Leg Cast Below Knee-Toe","PX-29405","CDM",29405,"CPT",{"$nulls":8},"both",null,null,233.76,233.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,163.63,55.9,78.49,"percent of total billed charges",null,"professional"]
["Application Short Leg Cast Walking/Ambulatory","PX-29425","CDM",29425,"CPT",{"$nulls":8},"both",null,null,219.87,219.87,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,153.91,51.79,73.73,"percent of total billed charges",null,"professional"]
["Application Short Leg Splint Calf Foot","PX-29515","CDM",29515,"CPT",{"$nulls":8},"both",null,null,210.42,210.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,147.29,47.38,70.62,"percent of total billed charges",null,"professional"]
["Strapping Unna Boot","PX-29580","CDM",29580,"CPT",{"$nulls":8},"both",null,null,184.35,184.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,129.05,24.43,61.76,"percent of total billed charges",null,"professional"]
["Removal/Bivalving Full Arm/Full Leg Cast","PX-29705","CDM",29705,"CPT",{"$nulls":8},"both",null,null,181.32,181.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,126.92,41.65,60.97,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 1 Level","PX-64490","CDM",64490,"CPT",{"$nulls":8},"both",null,null,557.85,557.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,390.5,99.97,186.74,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 2nd Level","PX-64491","CDM",64491,"CPT",{"$nulls":8},"both",null,null,279.54,279.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,195.68,55.73,93.72,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Crv/Thrc 3+ Level","PX-64492","CDM",64492,"CPT",{"$nulls":8},"both",null,null,280.53,280.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,196.37,56.71,94.04,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 1 Level","PX-64493","CDM",64493,"CPT",{"$nulls":8},"both",null,null,514.47,514.47,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,360.13,86.04,172.15,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 2nd Level","PX-64494","CDM",64494,"CPT",{"$nulls":8},"both",null,null,262.11,262.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,183.48,47.86,87.81,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Agt Pvrt Facet Jt Lmbr/Sac 3+ Level","PX-64495","CDM",64495,"CPT",{"$nulls":8},"both",null,null,262.11,262.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,183.48,48.84,87.81,"percent of total billed charges",null,"professional"]
["Myocardial Spect Multiple Studies|PROFESSIONAL COMPONENT","PX-78452","CDM",78452,"CPT",{"$nulls":8},"both",null,null,1267.53,1267.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",26,null,70,null,887.27,72.07,72.07,"percent of total billed charges",null,"professional"]
["Pcv13 Vaccine for Intramuscular Use","PX-90670","CDM",90670,"CPT",{"$nulls":8},"both",null,null,95.76,95.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,67.03,257.99,257.99,"percent of total billed charges",null,"professional"]
["Removal Foreign Body Intranasal Office Procedure","PX-30300","CDM",30300,"CPT",{"$nulls":8},"both",null,null,613.08,613.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,429.16,119.28,205.07,"percent of total billed charges",null,"professional"]
["Control Nasal Hemorrhage Anterior Simple","PX-30901","CDM",30901,"CPT",{"$nulls":8},"both",null,null,450.15,450.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,315.11,52.33,150.89,"percent of total billed charges",null,"professional"]
["Control Nasal Hemorrhage Anterior Complex","PX-30903","CDM",30903,"CPT",{"$nulls":8},"both",null,null,703.29,703.29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,492.3,71.2,235.58,"percent of total billed charges",null,"professional"]
["Ctrl Nsl Hemrrg Pst Nasal Packs&/Cautery 1st","PX-30905","CDM",30905,"CPT",{"$nulls":8},"both",null,null,1011.18,1011.18,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,707.83,97.94,338.61,"percent of total billed charges",null,"professional"]
["Ctrl Nsl Hemrrg Pst Nasal Packs&/Cautery Subsq","PX-30906","CDM",30906,"CPT",{"$nulls":8},"both",null,null,1083.78,1083.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,758.65,123.34,363.03,"percent of total billed charges",null,"professional"]
["Intubation Endotracheal Emergency Procedure","PX-31500","CDM",31500,"CPT",{"$nulls":8},"both",null,null,383.52,383.52,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,268.46,129.74,129.74,"percent of total billed charges",null,"professional"]
["Menb-4c Recombnt Prot & Outer Memb Vesic Vacc Im","PX-90620","CDM",90620,"CPT",{"$nulls":8},"both",null,null,290,290,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,203,null,null,"percent of total billed charges",null,"professional"]
["Iiv4 Vacc Presrv Free 0.5 Ml Dos for Im Use","PX-90686","CDM",90686,"CPT",{"$nulls":8},"both",null,null,67.05,67.05,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,46.94,null,null,"percent of total billed charges",null,"professional"]
["Injections Sclerosant for Spider Veins Lim/Trnk","PX-36468","CDM",36468,"CPT",{"$nulls":8},"both",null,null,330.78,330.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,231.55,null,null,"percent of total billed charges",null,"professional"]
["Esophagoscopy Flexible Transnasal Diagnostic","PX-43197","CDM",43197,"CPT",{"$nulls":8},"both",null,null,547.32,547.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,383.12,76.1,183.5,"percent of total billed charges",null,"professional"]
["Chemodenervation Muscle Neck Unilat for Dystonia","PX-64616","CDM",64616,"CPT",{"$nulls":8},"both",null,null,380.04,380.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,266.03,100.16,128.97,"percent of total billed charges",null,"professional"]
["Chemodenervation One Extremity 1-4 Muscle","PX-64642","CDM",64642,"CPT",{"$nulls":8},"both",null,null,429.54,429.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,300.68,99.11,144.95,"percent of total billed charges",null,"professional"]
["Chemodenervation 1 Extremity Ea Addl 1-4 Muscle","PX-64643","CDM",64643,"CPT",{"$nulls":8},"both",null,null,261.45,261.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,183.02,64.64,88.22,"percent of total billed charges",null,"professional"]
["Iiv4 Vacc Split Virus 0.5 Ml Dos for Im Use","PX-90688","CDM",90688,"CPT",{"$nulls":8},"both",null,null,62.61,62.61,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,43.83,null,null,"percent of total billed charges",null,"professional"]
["PR Lidocaine 1%","PX-J3490.22","CDM","J3490","HCPCS",{"$nulls":8},"both",null,null,24,24,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,16.8,null,null,"percent of total billed charges",null,"professional"]
["PR Marcaine .5%","PX-J3490.25","CDM","J3490","HCPCS",{"$nulls":8},"both",null,null,0.39,0.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,0.27,null,null,"percent of total billed charges",null,"professional"]
["Skyla, 13.5 mg","PX-J7301","CDM","J7301","HCPCS",{"$nulls":8},"both",null,null,2908,2908,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,2035.6,null,null,"percent of total billed charges",null,"professional"]
["Mirena, 52 mg","PX-J7298","CDM","J7298","HCPCS",{"$nulls":8},"both",null,null,3304,3304,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,2312.8,null,null,"percent of total billed charges",null,"professional"]
["Removal Impacted Cerumen Irrigation/Lvg Unilat","PX-69209","CDM",69209,"CPT",{"$nulls":8},"both",null,null,46.53,46.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,32.57,13.23,15.56,"percent of total billed charges",null,"professional"]
["Exc Lesion Tongue W/Clsr Anterior Two-Thirds","PX-41112","CDM",41112,"CPT",{"$nulls":8},"both",null,null,981.09,981.09,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,686.76,234.32,328.62,"percent of total billed charges",null,"professional"]
["Drg Absc Cst Hmtma From Dentoalveolar Struxs","PX-41800","CDM",41800,"CPT",{"$nulls":8},"both",null,null,847.17,847.17,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,593.02,149.11,283.36,"percent of total billed charges",null,"professional"]
["Esophagoscopy Flexible Transoral Diagnostic","PX-43200","CDM",43200,"CPT",{"$nulls":8},"both",null,null,762.69,762.69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,533.88,82.31,255.2,"percent of total billed charges",null,"professional"]
["Esophagogastroduodenoscopy Transoral Diagnostic","PX-43235","CDM",43235,"CPT",{"$nulls":8},"both",null,null,831.96,831.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,582.37,114.75,278.47,"percent of total billed charges",null,"professional"]
["Egd Transoral Biopsy Single/Multiple","PX-43239","CDM",43239,"CPT",{"$nulls":8},"both",null,null,1089.84,1089.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,762.89,129.51,364.61,"percent of total billed charges",null,"professional"]
["Egd Injection Sclerosis Esophgl/Gastric Varices","PX-43243","CDM",43243,"CPT",{"$nulls":8},"both",null,null,654,654,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,457.8,220.52,220.52,"percent of total billed charges",null,"professional"]
["Egd Dilation Gastric/Duodenal Stricture","PX-43245","CDM",43245,"CPT",{"$nulls":8},"both",null,null,1713.96,1713.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1199.77,162.98,573.27,"percent of total billed charges",null,"professional"]
["Egd Flexible Foreign Body Removal","PX-43247","CDM",43247,"CPT",{"$nulls":8},"both",null,null,1104.42,1104.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,773.09,164.6,369.9,"percent of total billed charges",null,"professional"]
["Egd Balloon Dilation Esophagus <30 Mm Diam","PX-43249","CDM",43249,"CPT",{"$nulls":8},"both",null,null,3126.72,3126.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,2188.7,143.28,1043.75,"percent of total billed charges",null,"professional"]
["Egd Removal Tumor Polyp/Other Lesion Snare Tech","PX-43251","CDM",43251,"CPT",{"$nulls":8},"both",null,null,1427.37,1427.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,999.16,182.62,477.64,"percent of total billed charges",null,"professional"]
["Moblj Splenic Flxr Pfrmd Conjunct W/Prtl Colct","PX-44139","CDM",44139,"CPT",{"$nulls":8},"both",null,null,319.35,319.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,223.55,108.66,108.66,"percent of total billed charges",null,"professional"]
["Colectomy Partial W/Anastomosis","PX-44140","CDM",44140,"CPT",{"$nulls":8},"both",null,null,3622.2,3622.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,2535.54,1231.05,1231.05,"percent of total billed charges",null,"professional"]
["Colectomy Prtl W/Coloproctostomy","PX-44145","CDM",44145,"CPT",{"$nulls":8},"both",null,null,4462.86,4462.86,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,3124,1514.72,1514.72,"percent of total billed charges",null,"professional"]
["Proctosgmdsc Rgd Dx W/WO Collj Spec Br/Wa Spx","PX-45300","CDM",45300,"CPT",{"$nulls":8},"both",null,null,370.29,370.29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,259.2,45.1,124.01,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Sbst Intrlmnr Crv/Thrc W/Img Gdn","PX-62321","CDM",62321,"CPT",{"$nulls":8},"both",null,null,2077.56,2077.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,534.47,101.78,255.35,"percent of total billed charges",null,"professional"]
["Njx Dx/Ther Sbst Intrlmnr Lmbr/Sac W/Img Gdn","PX-62323","CDM",62323,"CPT",{"$nulls":8},"both",null,null,2077.56,2077.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,525.95,94.08,251.25,"percent of total billed charges",null,"professional"]
["Colonoscopy Flx Dx W/Collj Spec When Pfrmd","PX-45378","CDM",45378,"CPT",{"$nulls":8},"both",null,null,975.48,975.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,682.84,171.81,327.02,"percent of total billed charges",null,"professional"]
["Colonoscopy W/Biopsy Single/Multiple","PX-45380","CDM",45380,"CPT",{"$nulls":8},"both",null,null,1249.98,1249.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,874.99,186.89,418.39,"percent of total billed charges",null,"professional"]
["Colsc Flx With Directed Submucosal Njx Any Sbst","PX-45381","CDM",45381,"CPT",{"$nulls":8},"both",null,null,1275.84,1275.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,893.09,186.56,427.23,"percent of total billed charges",null,"professional"]
["Colsc Flx W/Removal Lesion by Hot Bx Forceps","PX-45384","CDM",45384,"CPT",{"$nulls":8},"both",null,null,1398.51,1398.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,978.96,210.89,468.91,"percent of total billed charges",null,"professional"]
["Colsc Flx W/Rmvl of Tumor Polyp Lesion Snare Tq","PX-45385","CDM",45385,"CPT",{"$nulls":8},"both",null,null,1301.97,1301.97,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,911.38,236.4,436.46,"percent of total billed charges",null,"professional"]
["Colsc Flexible W/Transendoscopic Balloon Dilat","PX-45386","CDM",45386,"CPT",{"$nulls":8},"both",null,null,1758.69,1758.69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1231.08,197.06,588.35,"percent of total billed charges",null,"professional"]
["Hemorrhoidectomy Xtrnl 2/> Column/Group","PX-46250","CDM",46250,"CPT",{"$nulls":8},"both",null,null,1365.75,1365.75,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,956.03,302.36,458.88,"percent of total billed charges",null,"professional"]
["Surg Tx Anal Fistula Subq","PX-46270","CDM",46270,"CPT",{"$nulls":8},"both",null,null,1522.05,1522.05,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1065.44,382.34,511.68,"percent of total billed charges",null,"professional"]
["Anoscopy Dx W/Collj Spec Br/Wa Spx When Prfrmd","PX-46600","CDM",46600,"CPT",{"$nulls":8},"both",null,null,342.27,342.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,239.59,39.18,114.49,"percent of total billed charges",null,"professional"]
["Laparoscopy Surg Cholecystectomy","PX-47562","CDM",47562,"CPT",{"$nulls":8},"both",null,null,1796.52,1796.52,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1257.56,610.51,610.51,"percent of total billed charges",null,"professional"]
["Rpr 1st Ingun Hrna Age 5 Yrs/> Reducible","PX-49505","CDM",49505,"CPT",{"$nulls":8},"both",null,null,1432.02,1432.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1002.41,486.22,486.22,"percent of total billed charges",null,"professional"]
["Rpr Recrt Inguinal Hernia Any Age Reducible","PX-49520","CDM",49520,"CPT",{"$nulls":8},"both",null,null,1726.59,1726.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1208.61,586.71,586.71,"percent of total billed charges",null,"professional"]
["Rpr Ingun Hernia Sliding Any Age","PX-49525","CDM",49525,"CPT",{"$nulls":8},"both",null,null,1567.38,1567.38,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1097.17,532.36,532.36,"percent of total billed charges",null,"professional"]
["Rpr Small Omphalocele W/Primary Closure","PX-49600","CDM",49600,"CPT",{"$nulls":8},"both",null,null,1999.11,1999.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1399.38,679.45,679.45,"percent of total billed charges",null,"professional"]
["Laparoscopy Surg Rpr Initial Inguinal Hernia","PX-49650","CDM",49650,"CPT",{"$nulls":8},"both",null,null,1191.06,1191.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,833.74,404.14,404.14,"percent of total billed charges",null,"professional"]
["Laps Surg Rpr Recurrent Inguinal Hernia","PX-49651","CDM",49651,"CPT",{"$nulls":8},"both",null,null,1552.44,1552.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1086.71,526.89,526.89,"percent of total billed charges",null,"professional"]
["Kyleena, 19.5 mg","PX-J7296","CDM","J7296","HCPCS",{"$nulls":8},"both",null,null,3304,3304,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,2312.8,null,null,"percent of total billed charges",null,"professional"]
["Insj Non-Ndwellg Bladder Catheter","PX-51701","CDM",51701,"CPT",{"$nulls":8},"both",null,null,127.38,127.38,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,89.17,23.78,42.77,"percent of total billed charges",null,"professional"]
["Insj Temp Ndwellg Bladder Catheter Simple","PX-51702","CDM",51702,"CPT",{"$nulls":8},"both",null,null,180.06,180.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,126.04,23.61,60.28,"percent of total billed charges",null,"professional"]
["Change Cystostomy Tube Simple","PX-51705","CDM",51705,"CPT",{"$nulls":8},"both",null,null,281.13,281.13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,196.79,48.69,94.2,"percent of total billed charges",null,"professional"]
["Slitting Prepuce Dorsal/Lat Spx Xcp Newborn","PX-54001","CDM",54001,"CPT",{"$nulls":8},"both",null,null,573,573,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,401.1,134.24,192.2,"percent of total billed charges",null,"professional"]
["Tangential Biopsy Skin Single Lesion","PX-11102","CDM",11102,"CPT",{"$nulls":8},"both",null,null,292.41,292.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,204.69,35.57,97.78,"percent of total billed charges",null,"professional"]
["Tangential Biopsy Skin Ea Sep/Additional Lesion","PX-11103","CDM",11103,"CPT",{"$nulls":8},"both",null,null,145.89,145.89,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,102.12,20.65,48.81,"percent of total billed charges",null,"professional"]
["Punch Biopsy Skin Single Lesion","PX-11104","CDM",11104,"CPT",{"$nulls":8},"both",null,null,363.27,363.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,254.29,43.93,121.54,"percent of total billed charges",null,"professional"]
["Punch Biopsy Skin Ea Sep/Additional Lesion","PX-11105","CDM",11105,"CPT",{"$nulls":8},"both",null,null,172.2,172.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,120.54,23.94,57.66,"percent of total billed charges",null,"professional"]
["Incisional Biopsy Skin Single Lesion","PX-11106","CDM",11106,"CPT",{"$nulls":8},"both",null,null,450.84,450.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,315.59,52.95,150.86,"percent of total billed charges",null,"professional"]
["Incisional Biopsy Skin Ea Sep/Additional Lesion","PX-11107","CDM",11107,"CPT",{"$nulls":8},"both",null,null,205.98,205.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,144.19,28.69,68.97,"percent of total billed charges",null,"professional"]
["Perq Replacement Gtube Not Req Revj Gstrst Trc","PX-43762","CDM",43762,"CPT",{"$nulls":8},"both",null,null,655.56,655.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,458.89,34.13,219.14,"percent of total billed charges",null,"professional"]
["Perq Replacement Gtube Req Revj Gstrst Trc","PX-43763","CDM",43763,"CPT",{"$nulls":8},"both",null,null,965.94,965.94,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,676.16,81.19,323.17,"percent of total billed charges",null,"professional"]
["Comm svcs by rhc/fqhc 5 min","PX-G0071","CDM","G0071","HCPCS",{"$nulls":8},"both",null,null,74.28,74.28,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,52,null,null,"percent of total billed charges",null,"professional"]
["Remote Image Submitted by Pt","PX-G2010","CDM","G2010","HCPCS",{"$nulls":8},"both",null,null,35.73,35.73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,25.01,8.68,11.96,"percent of total billed charges",null,"professional"]
["Virtual Visit by MD/Qhp","PX-G2012","CDM","G2012","HCPCS",{"$nulls":8},"both",null,null,40.05,40.05,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,28.04,12.13,13.44,"percent of total billed charges",null,"professional"]
["Excision Hydrocele Unilateral","PX-55040","CDM",55040,"CPT",{"$nulls":8},"both",null,null,960.45,960.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,672.32,323.25,323.25,"percent of total billed charges",null,"professional"]
["Fit&Insj Pessary/Oth Intravaginal Support Devi","PX-57160","CDM",57160,"CPT",{"$nulls":8},"both",null,null,211.53,211.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,148.07,42.65,71.13,"percent of total billed charges",null,"professional"]
["Endometrial Bx W/WO Endocervix Bx W/O Dilat Spx","PX-58100","CDM",58100,"CPT",{"$nulls":8},"both",null,null,288.45,288.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,201.92,58.72,97.03,"percent of total billed charges",null,"professional"]
["Insertion Intrauterine Device Iud","PX-58300","CDM",58300,"CPT",{"$nulls":8},"both",null,null,325.15,325.15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,227.61,null,null,"percent of total billed charges",null,"professional"]
["Removal Intrauterine Device Iud","PX-58301","CDM",58301,"CPT",{"$nulls":8},"both",null,null,314.37,314.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,220.06,61.51,105.72,"percent of total billed charges",null,"professional"]
["Vaginal Delivery Only","PX-59409","CDM",59409,"CPT",{"$nulls":8},"both",null,null,2121.21,2121.21,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1484.85,724.35,724.35,"percent of total billed charges",null,"professional"]
["Delivery Placenta Separate Procedure","PX-59414","CDM",59414,"CPT",{"$nulls":8},"both",null,null,237.45,237.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,166.22,81.31,81.31,"percent of total billed charges",null,"professional"]
["Diagnostic Lumbar Spinal Puncture","PX-62270","CDM",62270,"CPT",{"$nulls":8},"both",null,null,414.84,414.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,290.39,57.94,139.48,"percent of total billed charges",null,"professional"]
["Therapeutic Spinal Puncture Drainage CSF","PX-62272","CDM",62272,"CPT",{"$nulls":8},"both",null,null,518.25,518.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,362.78,82.77,174.78,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Trigeminal Nerve Each Branch","PX-64400","CDM",64400,"CPT",{"$nulls":8},"both",null,null,323.22,323.22,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,226.25,47.43,108.66,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Greater Occipital Nerve","PX-64405","CDM",64405,"CPT",{"$nulls":8},"both",null,null,119.64,119.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,83.75,48.26,70.85,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Axillary Nerve W/Img Gdn","PX-64417","CDM",64417,"CPT",{"$nulls":8},"both",null,null,464.61,464.61,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,325.23,60.16,155.44,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Suprascapular Nerve","PX-64418","CDM",64418,"CPT",{"$nulls":8},"both",null,null,247.14,247.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,173,52.13,82.91,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Intercostal Nrv Single Lvl","PX-64420","CDM",64420,"CPT",{"$nulls":8},"both",null,null,282.72,282.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,197.9,55.07,94.69,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Intercostal Nrv Ea Addl Lvl","PX-64421","CDM",64421,"CPT",{"$nulls":8},"both",null,null,95.19,95.19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,66.63,23.44,31.95,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Pudendal Nerve","PX-64430","CDM",64430,"CPT",{"$nulls":8},"both",null,null,282.51,282.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,197.76,51.48,94.7,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Sciatic Nerve W/Img Gdn","PX-64445","CDM",64445,"CPT",{"$nulls":8},"both",null,null,467.58,467.58,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,327.31,67.86,153.65,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Other Peripheral Nerve/Branch","PX-64450","CDM",64450,"CPT",{"$nulls":8},"both",null,null,216.54,216.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,151.58,39.51,72.58,"percent of total billed charges",null,"professional"]
["Njx Aa&/Strd Tfrml Epi Lumbar/Sacral 1 Level","PX-64483","CDM",64483,"CPT",{"$nulls":8},"both",null,null,715.98,715.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,501.19,105.86,239.46,"percent of total billed charges",null,"professional"]
["Njx Aa&/Strd Tfrml Epi Lumbar/Sacral Ea Addl","PX-64484","CDM",64484,"CPT",{"$nulls":8},"both",null,null,322.02,322.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,225.41,48.52,107.78,"percent of total billed charges",null,"professional"]
["Injection Anes Agent Sphenopalatine Ganglion","PX-64505","CDM",64505,"CPT",{"$nulls":8},"both",null,null,406.8,406.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,284.76,97.95,137.24,"percent of total billed charges",null,"professional"]
["Njx Anes Stellate Ganglion Crv Sympathetic","PX-64510","CDM",64510,"CPT",{"$nulls":8},"both",null,null,424.95,424.95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,297.47,73.41,142.18,"percent of total billed charges",null,"professional"]
["Injection Anes Superior Hypogastric Plexus","PX-64517","CDM",64517,"CPT",{"$nulls":8},"both",null,null,562.14,562.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,393.5,120.11,188.22,"percent of total billed charges",null,"professional"]
["Injection Anes Lmbr/Thrc Paravertbrl Sympathetic","PX-64520","CDM",64520,"CPT",{"$nulls":8},"both",null,null,671.88,671.88,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,470.32,81.11,224.53,"percent of total billed charges",null,"professional"]
["Injx Anes Celiac Plexus W/WO Radiologic Monitrng","PX-64530","CDM",64530,"CPT",{"$nulls":8},"both",null,null,664.77,664.77,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,465.34,89.97,222.25,"percent of total billed charges",null,"professional"]
["Chemodnrvtj Musc Musc Innervated Facial Nrv Unil","PX-64612","CDM",64612,"CPT",{"$nulls":8},"both",null,null,390.45,390.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,273.32,113.13,131.47,"percent of total billed charges",null,"professional"]
["Dstrj Neurolytic Agent Other Peripheral Nerve","PX-64640","CDM",64640,"CPT",{"$nulls":8},"both",null,null,720.06,720.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,504.04,113.25,240.95,"percent of total billed charges",null,"professional"]
["Removal FB Eye Conjunctival Superficial","PX-65205","CDM",65205,"CPT",{"$nulls":8},"both",null,null,81.99,81.99,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,57.39,27.36,27.69,"percent of total billed charges",null,"professional"]
["Rmvl FB Xtrnl Eye Corneal W/O Slit Lamp","PX-65220","CDM",65220,"CPT",{"$nulls":8},"both",null,null,173.31,173.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,121.32,38.85,58.17,"percent of total billed charges",null,"professional"]
["Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp","PX-66984","CDM",66984,"CPT",{"$nulls":8},"both",null,null,1552.08,1552.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1086.46,519.79,519.79,"percent of total billed charges",null,"professional"]
["Diagnostic Lumbar Spinal Puncture W/Fluor or CT","PX-62328","CDM",62328,"CPT",{"$nulls":8},"both",null,null,641.94,641.94,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,449.36,79.83,214.73,"percent of total billed charges",null,"professional"]
["Therapeutic Spinal Pnxr Drainage CSF W/Fluor/CT","PX-62329","CDM",62329,"CPT",{"$nulls":8},"both",null,null,750.96,750.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,525.67,96.43,251.64,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Nerves Nrvtg Si Joint W/Img","PX-64451","CDM",64451,"CPT",{"$nulls":8},"both",null,null,663.42,663.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,464.39,77.35,221.76,"percent of total billed charges",null,"professional"]
["Injection Aa&/Strd Genicular Nrv Branches W/Img","PX-64454","CDM",64454,"CPT",{"$nulls":8},"both",null,null,645.72,645.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,452,78.01,215.86,"percent of total billed charges",null,"professional"]
["Destruction Neurolytic Agt Genicular Nerve W/Img","PX-64624","CDM",64624,"CPT",{"$nulls":8},"both",null,null,1131.42,1131.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,791.99,139.13,378.16,"percent of total billed charges",null,"professional"]
["Online Digital E/M Svc Est Pt <7 D 5-10 Minutes","PX-99421","CDM",99421,"CPT",{"$nulls":8},"both",null,null,42.99,42.99,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,30.09,12.13,14.42,"percent of total billed charges",null,"professional"]
["Online Digital E/M Svc Est Pt <7 D 11-20 Minutes","PX-99422","CDM",99422,"CPT",{"$nulls":8},"both",null,null,84.03,84.03,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,58.82,23.93,28.18,"percent of total billed charges",null,"professional"]
["Online Digital E/M Svc Est Pt <7 D 21+ Minutes","PX-99423","CDM",99423,"CPT",{"$nulls":8},"both",null,null,133.89,133.89,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,93.72,38.34,44.89,"percent of total billed charges",null,"professional"]
["Drainage External Ear Abscess/Hematoma Simple","PX-69000","CDM",69000,"CPT",{"$nulls":8},"both",null,null,538.11,538.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,376.68,120.79,180.38,"percent of total billed charges",null,"professional"]
["Rmvl FB Xtrnl Auditory Canal W/O Anes","PX-69200","CDM",69200,"CPT",{"$nulls":8},"both",null,null,231.06,231.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,161.74,44.76,77.5,"percent of total billed charges",null,"professional"]
["Removal Impacted Cerumen Instrumentation Unilat","PX-69210","CDM",69210,"CPT",{"$nulls":8},"both",null,null,136.59,136.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,95.61,30.5,45.89,"percent of total billed charges",null,"professional"]
["US Guidance Needle Placement Img S&I","PX-76942","CDM",76942,"CPT",{"$nulls":8},"both",null,null,168.51,168.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,117.96,27.67,56.34,"percent of total billed charges",null,"professional"]
["Dis site tele svcs rhc/fqhc","PX-G2025","CDM","G2025","HCPCS",{"$nulls":8},"both",null,null,285.81,285.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,200.07,null,null,"percent of total billed charges",null,"professional"]
["Prolonged Outpatient E/M Service Each 15 Minutes","PX-99417","CDM",99417,"CPT",{"$nulls":8},"both",null,null,90.37,90.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,63.26,29.66,30.97,"percent of total billed charges",null,"professional"]
["External Ecg Rec>7d<15d Recording","PX-93246","CDM",93246,"CPT",{"$nulls":8},"both",null,null,34.77,34.77,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,24.34,11.63,11.63,"percent of total billed charges",null,"professional"]
["Skin Test Tuberculosis Intradermal","PX-86580","CDM",86580,"CPT",{"$nulls":8},"both",null,null,29.85,29.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,20.9,9.99,9.99,"percent of total billed charges",null,"professional"]
["Cytp Cerv/Vag Auto Thin Layer Prep Mnl Screen","PX-88142","CDM",88142,"CPT",{"$nulls":8},"both",null,null,60.78,60.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,42.55,20.26,20.26,"percent of total billed charges",null,"professional"]
["Debridement Open Wound First 20 Sq Cm/<","PX-97597","CDM",97597,"CPT",{"$nulls":8},"both",null,null,294,294,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,205.8,33.43,98.27,"percent of total billed charges",null,"professional"]
["Im Adm Prq ID Subq/Im Njxs 1 Vaccine","PX-90471","CDM",90471,"CPT",{"$nulls":8},"both",null,null,60.3,60.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,42.21,20.14,20.14,"percent of total billed charges",null,"professional"]
["Im Adm Prq ID Subq/Im Njxs Ea Vaccine","PX-90472","CDM",90472,"CPT",{"$nulls":8},"both",null,null,42.63,42.63,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,29.84,14.25,14.25,"percent of total billed charges",null,"professional"]
["Iiv3 Vaccine Split Virus 0.5 Ml Dosage Im Use","PX-90658","CDM",90658,"CPT",{"$nulls":8},"both",null,null,37.65,37.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,26.36,21.86,21.86,"percent of total billed charges",null,"professional"]
["Tdap Vaccine 7 Yrs/> Im","PX-90715","CDM",90715,"CPT",{"$nulls":8},"both",null,null,114.9,114.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,80.43,38.52,38.52,"percent of total billed charges",null,"professional"]
["Ppsv23 Vaccine 2 Yrs or Older for Subq/Im Use","PX-90732","CDM",90732,"CPT",{"$nulls":8},"both",null,null,400.41,400.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,280.29,133.47,133.47,"percent of total billed charges",null,"professional"]
["Cardiopulmonary Resuscitation","PX-92950","CDM",92950,"CPT",{"$nulls":8},"both",null,null,929.55,929.55,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,650.69,170.82,311.62,"percent of total billed charges",null,"professional"]
["Cardioversion Elective Arrhythmia External","PX-92960","CDM",92960,"CPT",{"$nulls":8},"both",null,null,441.78,441.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,309.25,101.75,147.92,"percent of total billed charges",null,"professional"]
["Ecg Routine Ecg W/Least 12 Lds W/I&R","PX-93000","CDM",93000,"CPT",{"$nulls":8},"both",null,null,41.04,41.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,28.73,13.76,13.76,"percent of total billed charges",null,"professional"]
["Ecg Routine Ecg W/Least 12 Lds I&R Only","PX-93010","CDM",93010,"CPT",{"$nulls":8},"both",null,null,22.98,22.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,16.09,6.55,7.7,"percent of total billed charges",null,"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg W/Si&R","PX-93015","CDM",93015,"CPT",{"$nulls":8},"both",null,null,209.76,209.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,146.83,70.09,70.09,"percent of total billed charges",null,"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg W/O I&R","PX-93016","CDM",93016,"CPT",{"$nulls":8},"both",null,null,60.3,60.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,42.21,20.14,20.14,"percent of total billed charges",null,"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg Trcg Only","PX-93017","CDM",93017,"CPT",{"$nulls":8},"both",null,null,109.8,109.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,76.86,36.68,36.68,"percent of total billed charges",null,"professional"]
["Cv Strs Tst Xers&/or Rx Cont Ecg I&R Only","PX-93018","CDM",93018,"CPT",{"$nulls":8},"both",null,null,39.66,39.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,27.76,13.27,13.27,"percent of total billed charges",null,"professional"]
["Spmtry W/Vc Expiratory Flo W/WO Mxml Vol Vntj","PX-94010","CDM",94010,"CPT",{"$nulls":8},"both",null,null,79.35,79.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,55.55,7.7,26.53,"percent of total billed charges",null,"professional"]
["Brncdilat Rspse Spmtry Pre&Post-Brncdilat Admn","PX-94060","CDM",94060,"CPT",{"$nulls":8},"both",null,null,113.73,113.73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,79.61,9.67,37.99,"percent of total billed charges",null,"professional"]
["Vital Capacity Total Separate Procedure","PX-94150","CDM",94150,"CPT",{"$nulls":8},"both",null,null,74.66,74.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,52.26,null,null,"percent of total billed charges",null,"professional"]
["Pressurized/Nonpressurized Inhalation Treatment","PX-94640","CDM",94640,"CPT",{"$nulls":8},"both",null,null,22.98,22.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,16.09,7.7,7.7,"percent of total billed charges",null,"professional"]
["Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs 1 Njx","PX-95115","CDM",95115,"CPT",{"$nulls":8},"both",null,null,29.85,29.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,20.9,9.99,9.99,"percent of total billed charges",null,"professional"]
["Prof Svcs Allg Immntx X W/Prv Allgic Xtrcs Njxs","PX-95117","CDM",95117,"CPT",{"$nulls":8},"both",null,null,35.73,35.73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,25.01,11.96,11.96,"percent of total billed charges",null,"professional"]
["Rmvl Devital Tiss N-Slctv Dbrdmt W/O Anes 1 Sess","PX-97602","CDM",97602,"CPT",{"$nulls":8},"both",null,null,126.12,126.12,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,88.28,null,null,"percent of total billed charges",null,"professional"]
["Spec Reports > Usual Med Comunicaj/Stand Rprtg","PX-99080","CDM",99080,"CPT",{"$nulls":8},"both",null,null,103.26,103.26,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,72.28,null,null,"percent of total billed charges",null,"professional"]
["Unlisted Special Service Procedure/Report","PX-99199","CDM",99199,"CPT",{"$nulls":8},"both",null,null,105,105,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,73.5,null,null,"percent of total billed charges",null,"professional"]
["Office/Outpatient New Sf Mdm 15 Minutes","PX-99202","CDM",99202,"CPT",{"$nulls":8},"both",null,null,208.32,208.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,145.82,44.9,59.32,"percent of total billed charges",null,"professional"]
["Office/Outpatient New Low Mdm 30 Minutes","PX-99203","CDM",99203,"CPT",{"$nulls":8},"both",null,null,319.38,319.38,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,223.57,77.37,91.09,"percent of total billed charges",null,"professional"]
["Office/Outpatient New Moderate Mdm 45 Minutes","PX-99204","CDM",99204,"CPT",{"$nulls":8},"both",null,null,478.56,478.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,334.99,126.2,136.49,"percent of total billed charges",null,"professional"]
["Office/Outpatient New High Mdm 60 Minutes","PX-99205","CDM",99205,"CPT",{"$nulls":8},"both",null,null,630.27,630.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,441.19,171.6,211.55,"percent of total billed charges",null,"professional"]
["Office/Outpatient Est Pt May Not Req Phys/Qhp","PX-99211","CDM",99211,"CPT",{"$nulls":8},"both",null,null,68.16,68.16,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,47.71,8.36,22.76,"percent of total billed charges",null,"professional"]
["Office/Outpatient Established Sf Mdm 10 Min","PX-99212","CDM",99212,"CPT",{"$nulls":8},"both",null,null,163.35,163.35,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,114.35,33.43,46.51,"percent of total billed charges",null,"professional"]
["Office/Outpatient Established Low Mdm 20 Min","PX-99213","CDM",99213,"CPT",{"$nulls":8},"both",null,null,262.11,262.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,183.48,62.6,74.64,"percent of total billed charges",null,"professional"]
["Office/Outpatient Established Mod Mdm 30 Min","PX-99214","CDM",99214,"CPT",{"$nulls":8},"both",null,null,369.69,369.69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,258.78,92.42,105.27,"percent of total billed charges",null,"professional"]
["Office/Outpatient Established High Mdm 40 Min","PX-99215","CDM",99215,"CPT",{"$nulls":8},"both",null,null,519.06,519.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,363.34,136.99,147.89,"percent of total billed charges",null,"professional"]
["1st Hospital IP/Obs Care Sf/Low Mdm 40 Minutes","PX-99221","CDM",99221,"CPT",{"$nulls":8},"both",null,null,230.73,230.73,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,161.51,77.7,77.7,"percent of total billed charges",null,"professional"]
["1st Hospital IP/Obs Care Moderate Mdm 55 Minutes","PX-99222","CDM",99222,"CPT",{"$nulls":8},"both",null,null,367.17,367.17,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,257.02,123.41,123.41,"percent of total billed charges",null,"professional"]
["1st Hospital IP/Obs Care High Mdm 75 Minutes","PX-99223","CDM",99223,"CPT",{"$nulls":8},"both",null,null,489.12,489.12,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,342.38,164.19,164.19,"percent of total billed charges",null,"professional"]
["Sbsq Hospital IP/Obs Care Sf/Low Mdm 25 Minutes","PX-99231","CDM",99231,"CPT",{"$nulls":8},"both",null,null,138.93,138.93,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,97.25,46.71,46.71,"percent of total billed charges",null,"professional"]
["Sbsq Hospital IP/Obs Care Mod Mdm 35 Minutes","PX-99232","CDM",99232,"CPT",{"$nulls":8},"both",null,null,222.57,222.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,155.8,74.72,74.72,"percent of total billed charges",null,"professional"]
["Sbsq Hospital IP/Obs Care High Mdm 50 Minutes","PX-99233","CDM",99233,"CPT",{"$nulls":8},"both",null,null,334.86,334.86,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,234.4,112.41,112.41,"percent of total billed charges",null,"professional"]
["Hospital IP/Obs Care Same Date Sf/Low Mdm 45 Min","PX-99234","CDM",99234,"CPT",{"$nulls":8},"both",null,null,274.56,274.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,192.19,92.27,92.27,"percent of total billed charges",null,"professional"]
["Hospital IP/Obs Care Same Date Mod Mdm 70 Min","PX-99235","CDM",99235,"CPT",{"$nulls":8},"both",null,null,450.06,450.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,315.04,151.08,151.08,"percent of total billed charges",null,"professional"]
["Hospital IP/Obs Care Same Date High Mdm 85 Min","PX-99236","CDM",99236,"CPT",{"$nulls":8},"both",null,null,587.64,587.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,411.35,197.3,197.3,"percent of total billed charges",null,"professional"]
["Hospital IP/Obs Discharge Day Mgmt 30 Min/<","PX-99238","CDM",99238,"CPT",{"$nulls":8},"both",null,null,230.07,230.07,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,161.05,77.17,77.17,"percent of total billed charges",null,"professional"]
["Hospital IP/Obs Discharge Day Mgmt > 30 Min","PX-99239","CDM",99239,"CPT",{"$nulls":8},"both",null,null,324.87,324.87,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,227.41,108.96,108.96,"percent of total billed charges",null,"professional"]
["IP/Obs Consltj New/Est Pt Sf Mdm 35 Minutes","PX-99252","CDM",99252,"CPT",{"$nulls":8},"both",null,null,207.27,207.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,145.09,null,null,"percent of total billed charges",null,"professional"]
["Emergency Department Visit May Not Req Phys/Qhp","PX-99281","CDM",99281,"CPT",{"$nulls":8},"both",null,null,31.59,31.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,22.11,10.66,10.66,"percent of total billed charges",null,"professional"]
["Emergency Department Visit Straightforward Mdm","PX-99282","CDM",99282,"CPT",{"$nulls":8},"both",null,null,115.74,115.74,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,81.02,39.02,39.02,"percent of total billed charges",null,"professional"]
["Emergency Department Visit Low Mdm","PX-99283","CDM",99283,"CPT",{"$nulls":8},"both",null,null,196.95,196.95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,137.87,66.4,66.4,"percent of total billed charges",null,"professional"]
["Emergency Department Visit Moderate Mdm","PX-99284","CDM",99284,"CPT",{"$nulls":8},"both",null,null,335.04,335.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,234.53,112.97,112.97,"percent of total billed charges",null,"professional"]
["Emergency Department Visit High Mdm","PX-99285","CDM",99285,"CPT",{"$nulls":8},"both",null,null,485.31,485.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,339.72,163.63,163.63,"percent of total billed charges",null,"professional"]
["Critical Care Ill/Injured Patient Init 30-74 Min","PX-99291","CDM",99291,"CPT",{"$nulls":8},"both",null,null,778.05,778.05,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,544.64,199.97,261.21,"percent of total billed charges",null,"professional"]
["Critical Care Ill/Injured Patient Addl 30 Min","PX-99292","CDM",99292,"CPT",{"$nulls":8},"both",null,null,337.71,337.71,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,236.4,100.49,113.59,"percent of total billed charges",null,"professional"]
["Nursing Facility Dschrg Mgmt 30 Min/< Tot Time","PX-99315","CDM",99315,"CPT",{"$nulls":8},"both",null,null,232.62,232.62,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,162.83,66.29,77.99,"percent of total billed charges",null,"professional"]
["Nursing Facility Dschrg Mgmt 30 Min+ Tot Time","PX-99316","CDM",99316,"CPT",{"$nulls":8},"both",null,null,372.78,372.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,260.95,125.01,125.01,"percent of total billed charges",null,"professional"]
["Home/Res Visit New Patient Sf Mdm 15 Minutes","PX-99341","CDM",99341,"CPT",{"$nulls":8},"both",null,null,141.36,141.36,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,98.95,47.34,47.34,"percent of total billed charges",null,"professional"]
["Home/Res Visit New Patient Low Mdm 30 Minutes","PX-99342","CDM",99342,"CPT",{"$nulls":8},"both",null,null,224.04,224.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,156.83,75.03,75.03,"percent of total billed charges",null,"professional"]
["Home/Res Visit New Patient Mod Mdm 60 Minutes","PX-99344","CDM",99344,"CPT",{"$nulls":8},"both",null,null,405.81,405.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,284.07,135.98,135.98,"percent of total billed charges",null,"professional"]
["Home/Res Visit New Patient High Mdm 75 Minutes","PX-99345","CDM",99345,"CPT",{"$nulls":8},"both",null,null,575.19,575.19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,402.63,192.84,192.84,"percent of total billed charges",null,"professional"]
["Home/Res Visit Est Patient Sf Mdm 20 Minutes","PX-99347","CDM",99347,"CPT",{"$nulls":8},"both",null,null,129.57,129.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,90.7,43.41,43.41,"percent of total billed charges",null,"professional"]
["Home/Res Visit Est Patient Low Mdm 30 Minutes","PX-99348","CDM",99348,"CPT",{"$nulls":8},"both",null,null,219.12,219.12,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,153.38,73.39,73.39,"percent of total billed charges",null,"professional"]
["Home/Res Visit Est Patient Mod Mdm 40 Minutes","PX-99349","CDM",99349,"CPT",{"$nulls":8},"both",null,null,362.58,362.58,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,253.81,121.57,121.57,"percent of total billed charges",null,"professional"]
["Home/Res Visit Est Patient High Mdm 60 Minutes","PX-99350","CDM",99350,"CPT",{"$nulls":8},"both",null,null,527.67,527.67,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,369.37,176.95,176.95,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Patient <1year","PX-99381","CDM",99381,"CPT",{"$nulls":8},"both",null,null,321.22,321.22,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,224.85,null,null,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Pt Age 1-4 Yrs","PX-99382","CDM",99382,"CPT",{"$nulls":8},"both",null,null,335.95,335.95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,235.17,null,null,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Pt Age 5-11 Yrs","PX-99383","CDM",99383,"CPT",{"$nulls":8},"both",null,null,348.72,348.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,244.1,null,null,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Pt Age 12-17 Yr","PX-99384","CDM",99384,"CPT",{"$nulls":8},"both",null,null,390.96,390.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,273.67,null,null,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Pt Age 18-39yrs","PX-99385","CDM",99385,"CPT",{"$nulls":8},"both",null,null,380.16,380.16,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,266.11,null,null,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Patient 40-64yrs","PX-99386","CDM",99386,"CPT",{"$nulls":8},"both",null,null,438.11,438.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,306.68,null,null,"percent of total billed charges",null,"professional"]
["Initial Preventive Medicine New Patient 65yrs&>","PX-99387","CDM",99387,"CPT",{"$nulls":8},"both",null,null,475.44,475.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,332.81,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Established Patient <1y","PX-99391","CDM",99391,"CPT",{"$nulls":8},"both",null,null,288.8,288.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,202.16,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Est Patient 1-4yrs","PX-99392","CDM",99392,"CPT",{"$nulls":8},"both",null,null,307.47,307.47,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,215.23,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Est Patient 5-11yrs","PX-99393","CDM",99393,"CPT",{"$nulls":8},"both",null,null,306.48,306.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,214.54,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Est Patient 12-17yrs","PX-99394","CDM",99394,"CPT",{"$nulls":8},"both",null,null,334.97,334.97,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,234.48,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Est Patient 18-39 Yrs","PX-99395","CDM",99395,"CPT",{"$nulls":8},"both",null,null,342.83,342.83,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,239.98,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Est Patient 40-64yrs","PX-99396","CDM",99396,"CPT",{"$nulls":8},"both",null,null,364.44,364.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,255.11,null,null,"percent of total billed charges",null,"professional"]
["Periodic Preventive Med Est Patient 65yrs& Older","PX-99397","CDM",99397,"CPT",{"$nulls":8},"both",null,null,391.95,391.95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,274.37,null,null,"percent of total billed charges",null,"professional"]
["Unlisted Evaluation and Management Service","PX-99499","CDM",99499,"CPT",{"$nulls":8},"both",null,null,115.91,115.91,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,81.14,null,null,"percent of total billed charges",null,"professional"]
["Admin Influenza Virus Vac","PX-G0008","CDM","G0008","HCPCS",{"$nulls":8},"both",null,null,95.76,95.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,67.03,null,null,"percent of total billed charges",null,"professional"]
["Admin Pneumococcal Vaccine","PX-G0009","CDM","G0009","HCPCS",{"$nulls":8},"both",null,null,95.76,95.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,67.03,null,null,"percent of total billed charges",null,"professional"]
["Ca Screen;Pelvic/Breast Exam","PX-G0101","CDM","G0101","HCPCS",{"$nulls":8},"both",null,null,111.66,111.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,78.16,25.74,37.53,"percent of total billed charges",null,"professional"]
["Prostate Ca Screening; Dre","PX-G0102","CDM","G0102","HCPCS",{"$nulls":8},"both",null,null,68.16,68.16,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,47.71,8.36,22.76,"percent of total billed charges",null,"professional"]
["Colorectal Scrn; Hi Risk Ind","PX-G0105","CDM","G0105","HCPCS",{"$nulls":8},"both",null,null,975.48,975.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,682.84,171.81,327.02,"percent of total billed charges",null,"professional"]
["Colon Ca Scrn Not Hi Rsk Ind","PX-G0121","CDM","G0121","HCPCS",{"$nulls":8},"both",null,null,975.87,975.87,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,683.11,171.98,327.19,"percent of total billed charges",null,"professional"]
["Ldct Eligibility Visit","PX-G0296","CDM","G0296","HCPCS",{"$nulls":8},"both",null,null,79.71,79.71,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,55.8,24.08,26.7,"percent of total billed charges",null,"professional"]
["Injection,onabotulinumtoxinA","PX-J0585","CDM","J0585","HCPCS",{"$nulls":8},"both",null,null,18.96,18.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,13.27,6.41,6.41,"percent of total billed charges",null,"professional"]
["Ceftriaxone Sodium Injection","PX-J0696","CDM","J0696","HCPCS",{"$nulls":8},"both",null,null,1.47,1.47,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1.03,0.44,0.44,"percent of total billed charges",null,"professional"]
["Dexamethasone 1mg Inj","PX-J1100","CDM","J1100","HCPCS",{"$nulls":8},"both",null,null,0.33,0.33,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,0.23,0.11,0.11,"percent of total billed charges",null,"professional"]
["Diphenhydramine Hcl Injectio","PX-J1200","CDM","J1200","HCPCS",{"$nulls":8},"both",null,null,2.4,2.4,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1.68,0.75,0.75,"percent of total billed charges",null,"professional"]
["Inj Enoxaparin Sodium","PX-J1650","CDM","J1650","HCPCS",{"$nulls":8},"both",null,null,2.04,2.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1.43,0.57,0.57,"percent of total billed charges",null,"professional"]
["PR Ketorolac Tromethamine Inj, per 15mg","PX-J1885","CDM","J1885","HCPCS",{"$nulls":8},"both",null,null,1.47,1.47,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1.03,0.68,0.68,"percent of total billed charges",null,"professional"]
["Ondansetron Hcl Injection","PX-J2405","CDM","J2405","HCPCS",{"$nulls":8},"both",null,null,0.3,0.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,0.21,0.09,0.09,"percent of total billed charges",null,"professional"]
["Promethazine Hcl Injection","PX-J2550","CDM","J2550","HCPCS",{"$nulls":8},"both",null,null,10.8,10.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,7.56,3.31,3.31,"percent of total billed charges",null,"professional"]
["Methylprednisolone Injection","PX-J2930","CDM","J2930","HCPCS",{"$nulls":8},"both",null,null,17.67,17.67,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,12.37,null,null,"percent of total billed charges",null,"professional"]
["Triamcinolone Acetonide Inj","PX-J3301","CDM","J3301","HCPCS",{"$nulls":8},"both",null,null,2.85,2.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,2,0.9,0.9,"percent of total billed charges",null,"professional"]
["Vitamin B12 Injection","PX-J3420","CDM","J3420","HCPCS",{"$nulls":8},"both",null,null,4.32,4.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,3.02,1.15,1.15,"percent of total billed charges",null,"professional"]
["Intraut Copper Contraceptive","PX-J7300","CDM","J7300","HCPCS",{"$nulls":8},"both",null,null,436,436,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,305.2,null,null,"percent of total billed charges",null,"professional"]
["Ipratropium Brom Inh Sol U D","PX-J7644","CDM","J7644","HCPCS",{"$nulls":8},"both",null,null,0.96,0.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,0.67,0.36,0.36,"percent of total billed charges",null,"professional"]
["Screen Pap by Tech W MD Supv","PX-P3000","CDM","P3000","HCPCS",{"$nulls":8},"both",null,null,129.45,129.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,90.62,17.76,17.76,"percent of total billed charges",null,"professional"]
["Obtaining Screen Pap Smear","PX-Q0091","CDM","Q0091","HCPCS",{"$nulls":8},"both",null,null,129.45,129.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,90.62,17.37,43.23,"percent of total billed charges",null,"professional"]
["Telehealth Facility Fee","PX-Q3014","CDM","Q3014","HCPCS",{"$nulls":8},"both",null,null,89.88,89.88,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,62.92,null,null,"percent of total billed charges",null,"professional"]
["Removal of Sutures","PX-S0630","CDM","S0630","HCPCS",{"$nulls":8},"both",null,null,386,386,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,270.2,null,null,"percent of total billed charges",null,"professional"]
["Tube Thoracostomy Includes Water Seal","PX-32551","CDM",32551,"CPT",{"$nulls":8},"both",null,null,418.71,418.71,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,293.1,141.91,141.91,"percent of total billed charges",null,"professional"]
["Iiv Vaccine Preserv Free Increased Ag Content Im","PX-90662","CDM",90662,"CPT",{"$nulls":8},"both",null,null,220.2,220.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,154.14,83.49,83.49,"percent of total billed charges",null,"professional"]
["Tobacco Use Cessation Intermediate 3-10 Minutes","PX-99406","CDM",99406,"CPT",{"$nulls":8},"both",null,null,42.82,42.82,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,29.97,11.14,14.09,"percent of total billed charges",null,"professional"]
["Tobacco Use Cessation Intensive >10 Minutes","PX-99407","CDM",99407,"CPT",{"$nulls":8},"both",null,null,78.12,78.12,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,54.68,23.6,26.22,"percent of total billed charges",null,"professional"]
["Phys/Qhp Telephone Evaluation 5-10 Min","PX-99441","CDM",99441,"CPT",{"$nulls":8},"both",null,null,162.99,162.99,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,114.09,33.26,46.37,"percent of total billed charges",null,"professional"]
["Phys/Qhp Telephone Evaluation 11-20 Min","PX-99442","CDM",99442,"CPT",{"$nulls":8},"both",null,null,261.72,261.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,183.2,62.43,74.49,"percent of total billed charges",null,"professional"]
["Phys/Qhp Telephone Evaluation 21-30 Min","PX-99443","CDM",99443,"CPT",{"$nulls":8},"both",null,null,369.69,369.69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,258.78,92.42,123.85,"percent of total billed charges",null,"professional"]
["Fine Needle Aspiration Bx W/O Img Gdn 1st Lesion","PX-10021","CDM",10021,"CPT",{"$nulls":8},"both",null,null,290.13,290.13,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,203.09,51.16,97.33,"percent of total billed charges",null,"professional"]
["Incision & Drainage Abscess Simple/Single","PX-10060","CDM",10060,"CPT",{"$nulls":8},"both",null,null,368.34,368.34,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,257.84,103.38,123.35,"percent of total billed charges",null,"professional"]
["Incision & Drainage Abscess Complicated/Multiple","PX-10061","CDM",10061,"CPT",{"$nulls":8},"both",null,null,751.14,751.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,525.8,177,206.79,"percent of total billed charges",null,"professional"]
["Incision & Drainage Pilonidal Cyst Simple","PX-10080","CDM",10080,"CPT",{"$nulls":8},"both",null,null,728.52,728.52,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,509.96,100.96,243.73,"percent of total billed charges",null,"professional"]
["Incision & Removal Foreign Body Subq Tiss Simple","PX-10120","CDM",10120,"CPT",{"$nulls":8},"both",null,null,441.78,441.78,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,309.25,102.08,147.92,"percent of total billed charges",null,"professional"]
["Incision & Removal Foreign Body Subq Tiss Comp","PX-10121","CDM",10121,"CPT",{"$nulls":8},"both",null,null,758.64,758.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,531.05,174.42,254.65,"percent of total billed charges",null,"professional"]
["I&D Hematoma Seroma/Fluid Collection","PX-10140","CDM",10140,"CPT",{"$nulls":8},"both",null,null,490.2,490.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,343.14,113.58,164.33,"percent of total billed charges",null,"professional"]
["Puncture Aspiration Abscess Hematoma Bulla/Cyst","PX-10160","CDM",10160,"CPT",{"$nulls":8},"both",null,null,374.37,374.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,262.06,92.76,125.5,"percent of total billed charges",null,"professional"]
["Dbrdmt Extensv Eczmt/Infct Skin Up 10% Bdy Surf","PX-11000","CDM",11000,"CPT",{"$nulls":8},"both",null,null,171.81,171.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,120.27,26.06,57.49,"percent of total billed charges",null,"professional"]
["Debridement Subcutaneous Tissue 1st 20 Sq Cm/<","PX-11042","CDM",11042,"CPT",{"$nulls":8},"both",null,null,375.21,375.21,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,262.65,57.21,125.65,"percent of total billed charges",null,"professional"]
["Debridement Muscle &/Fascia 1st 20 Sq Cm/<","PX-11043","CDM",11043,"CPT",{"$nulls":8},"both",null,null,662.37,662.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,463.66,143.64,222.56,"percent of total billed charges",null,"professional"]
["Paring/Cutting Benign Hyperkeratotic Lesion 1","PX-11055","CDM",11055,"CPT",{"$nulls":8},"both",null,null,208.41,208.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,145.89,14.59,69.6,"percent of total billed charges",null,"professional"]
["Rmvl Skin Tags Mlt Fibrq Tags Any Up to&Inc 15","PX-11200","CDM",11200,"CPT",{"$nulls":8},"both",null,null,268.62,268.62,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,188.03,74.22,89.93,"percent of total billed charges",null,"professional"]
["Rmvl Skin Tags Mlt Fibrq Tags Any Ea Addl 10","PX-11201","CDM",11201,"CPT",{"$nulls":8},"both",null,null,52.2,52.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,36.54,15.24,17.53,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 Trunk/Arm/Leg Diam 0.5cm/<","PX-11300","CDM",11300,"CPT",{"$nulls":8},"both",null,null,292.41,292.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,204.69,31.96,97.78,"percent of total billed charges",null,"professional"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam 0.6-1.0 Cm","PX-11301","CDM",11301,"CPT",{"$nulls":8},"both",null,null,352.47,352.47,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,246.73,48.19,117.93,"percent of total billed charges",null,"professional"]
["Shvg Skn Lesion 1 Trunk/Arm/Leg Diam 1.1-2.0 Cm","PX-11302","CDM",11302,"CPT",{"$nulls":8},"both",null,null,398.04,398.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,278.63,56.22,133.17,"percent of total billed charges",null,"professional"]
["Shvg Skin Lesion 1 Trunk/Arm/Leg Diam >2.0 Cm","PX-11303","CDM",11303,"CPT",{"$nulls":8},"both",null,null,439.44,439.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,307.61,66.88,147.1,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 0.5 Cm/<","PX-11305","CDM",11305,"CPT",{"$nulls":8},"both",null,null,306.18,306.18,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,214.33,35.24,102.36,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 0.6-1.0 Cm","PX-11306","CDM",11306,"CPT",{"$nulls":8},"both",null,null,356.04,356.04,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,249.23,46.06,119.08,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam 1.1-2.0 Cm","PX-11307","CDM",11307,"CPT",{"$nulls":8},"both",null,null,401.37,401.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,280.96,58.68,134.32,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 S/N/H/F/G Diam >2.0 Cm","PX-11308","CDM",11308,"CPT",{"$nulls":8},"both",null,null,422.37,422.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,295.66,65.72,141.36,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 F/E/E/N/L/M Diam 0.5 Cm/<","PX-11310","CDM",11310,"CPT",{"$nulls":8},"both",null,null,336.39,336.39,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,235.47,42.78,112.53,"percent of total billed charges",null,"professional"]
["Shvg Skin Lesion 1 F/E/E/N/L/M Diam 0.6-1.0 Cm","PX-11311","CDM",11311,"CPT",{"$nulls":8},"both",null,null,396.45,396.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,277.52,59.01,132.68,"percent of total billed charges",null,"professional"]
["Shvg Skin Lesion 1 F/E/E/N/L/M Diam 1.1-2.0 Cm","PX-11312","CDM",11312,"CPT",{"$nulls":8},"both",null,null,450.24,450.24,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,315.17,69.82,150.7,"percent of total billed charges",null,"professional"]
["Shaving Skin Lesion 1 F/E/E/N/L/M Diam >2.0 Cm","PX-11313","CDM",11313,"CPT",{"$nulls":8},"both",null,null,522.84,522.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,365.99,90.32,175.12,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.5 Cm/<","PX-11400","CDM",11400,"CPT",{"$nulls":8},"both",null,null,372.87,372.87,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,261.01,81.6,124.82,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 0.6-1.0 Cm","PX-11401","CDM",11401,"CPT",{"$nulls":8},"both",null,null,452.97,452.97,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,317.08,101.92,151.69,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 1.1-2.0 Cm","PX-11402","CDM",11402,"CPT",{"$nulls":8},"both",null,null,498.3,498.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,348.81,111.27,166.94,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 2.1-3.0 Cm","PX-11403","CDM",11403,"CPT",{"$nulls":8},"both",null,null,571.05,571.05,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,399.74,143.73,191.54,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L 3.1-4.0 Cm","PX-11404","CDM",11404,"CPT",{"$nulls":8},"both",null,null,643.8,643.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,450.66,157.2,216.14,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg T/a/L >4.0 Cm","PX-11406","CDM",11406,"CPT",{"$nulls":8},"both",null,null,905.91,905.91,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,634.14,234.82,304.89,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 0.5 Cm/<","PX-11420","CDM",11420,"CPT",{"$nulls":8},"both",null,null,369.18,369.18,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,258.43,79.62,123.5,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 0.6-1.0cm","PX-11421","CDM",11421,"CPT",{"$nulls":8},"both",null,null,463.17,463.17,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,324.22,105.04,155.14,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 1.1-2.0cm","PX-11422","CDM",11422,"CPT",{"$nulls":8},"both",null,null,518.7,518.7,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,363.09,130.93,173.82,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 2.1-3.0cm","PX-11423","CDM",11423,"CPT",{"$nulls":8},"both",null,null,592.65,592.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,414.86,150.94,198.74,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G 3.1-4.0cm","PX-11424","CDM",11424,"CPT",{"$nulls":8},"both",null,null,682.86,682.86,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,478,172.93,229.25,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg S/N/H/F/G > 4.0cm","PX-11426","CDM",11426,"CPT",{"$nulls":8},"both",null,null,933.27,933.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,653.29,253.95,313.88,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M 0.5cm/<","PX-11440","CDM",11440,"CPT",{"$nulls":8},"both",null,null,418.68,418.68,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,293.08,104.35,140.04,"percent of total billed charges",null,"professional"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 0.6-1.0cm","PX-11441","CDM",11441,"CPT",{"$nulls":8},"both",null,null,504.57,504.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,353.2,128.8,169.07,"percent of total billed charges",null,"professional"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 1.1-2.0cm","PX-11442","CDM",11442,"CPT",{"$nulls":8},"both",null,null,559.11,559.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,391.38,141.59,187.43,"percent of total billed charges",null,"professional"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 2.1-3.0cm","PX-11443","CDM",11443,"CPT",{"$nulls":8},"both",null,null,656.4,656.4,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,459.48,171.76,220.22,"percent of total billed charges",null,"professional"]
["Exc B9 Les Mrgn Xcp Sk Tg F/E/E/N/L/M 3.1-4.0cm","PX-11444","CDM",11444,"CPT",{"$nulls":8},"both",null,null,812.19,812.19,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,568.53,215.37,272.68,"percent of total billed charges",null,"professional"]
["Exc B9 Lesion Mrgn Xcp Sk Tg F/E/E/N/L/M > 4.0cm","PX-11446","CDM",11446,"CPT",{"$nulls":8},"both",null,null,1095.27,1095.27,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,766.69,301.3,368.1,"percent of total billed charges",null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 0.5 Cm/<","PX-11600","CDM",11600,"CPT",{"$nulls":8},"both",null,null,571.14,571.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,399.8,117.02,191.35,"percent of total billed charges",null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 0.6-1.0 Cm","PX-11601","CDM",11601,"CPT",{"$nulls":8},"both",null,null,661.65,661.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,463.16,141.76,221.65,"percent of total billed charges",null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 1.1-2.0 Cm","PX-11602","CDM",11602,"CPT",{"$nulls":8},"both",null,null,708.81,708.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,496.17,154.2,237.37,"percent of total billed charges",null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 2.1-3.0 Cm","PX-11603","CDM",11603,"CPT",{"$nulls":8},"both",null,null,803.52,803.52,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,562.46,183.56,269.35,"percent of total billed charges",null,"professional"]
["Excision Mal Lesion Trunk/Arm/Leg 3.1-4.0 Cm","PX-11604","CDM",11604,"CPT",{"$nulls":8},"both",null,null,892.98,892.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,625.09,201.28,299.52,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion Trunk/Arm/Leg > 4.0 Cm","PX-11606","CDM",11606,"CPT",{"$nulls":8},"both",null,null,1272.33,1272.33,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,890.63,296,427.96,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 0.5 Cm/<","PX-11620","CDM",11620,"CPT",{"$nulls":8},"both",null,null,573.48,573.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,401.44,117.84,192.17,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 0.6-1.0 Cm","PX-11621","CDM",11621,"CPT",{"$nulls":8},"both",null,null,666,666,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,466.2,142.25,222.15,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 1.1-2.0 Cm","PX-11622","CDM",11622,"CPT",{"$nulls":8},"both",null,null,731.91,731.91,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,512.34,161.43,245.25,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 2.1-3.0 Cm","PX-11623","CDM",11623,"CPT",{"$nulls":8},"both",null,null,850.98,850.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,595.69,198.33,285.42,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion S/N/H/F/G 3.1-4.0 Cm","PX-11624","CDM",11624,"CPT",{"$nulls":8},"both",null,null,965.49,965.49,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,675.84,224.59,324.13,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion S/N/H/F/G >4.0 Cm","PX-11626","CDM",11626,"CPT",{"$nulls":8},"both",null,null,1152.69,1152.69,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,806.88,272.37,387.63,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 0.5 Cm/<","PX-11640","CDM",11640,"CPT",{"$nulls":8},"both",null,null,589.41,589.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,412.59,121.43,197.4,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 0.6-1.0 Cm","PX-11641","CDM",11641,"CPT",{"$nulls":8},"both",null,null,684.99,684.99,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,479.49,148.32,229.52,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 1.1-2.0 Cm","PX-11642","CDM",11642,"CPT",{"$nulls":8},"both",null,null,773.07,773.07,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,541.15,173.08,259.2,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 2.1-3.0 Cm","PX-11643","CDM",11643,"CPT",{"$nulls":8},"both",null,null,903.33,903.33,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,632.33,215.06,303.14,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion F/E/E/N/L 3.1-4.0 Cm","PX-11644","CDM",11644,"CPT",{"$nulls":8},"both",null,null,1111.68,1111.68,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,778.18,265.57,373.3,"percent of total billed charges",null,"professional"]
["Excision Malignant Lesion F/E/E/N/L >4.0 Cm","PX-11646","CDM",11646,"CPT",{"$nulls":8},"both",null,null,1430.1,1430.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1001.07,364.5,481.07,"percent of total billed charges",null,"professional"]
["Trimming Nondystrophic Nails Any Number","PX-11719","CDM",11719,"CPT",{"$nulls":8},"both",null,null,41.64,41.64,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,29.15,7.05,13.92,"percent of total billed charges",null,"professional"]
["Avulsion Nail Plate Partial/Complete Simple 1","PX-11730","CDM",11730,"CPT",{"$nulls":8},"both",null,null,334.41,334.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,234.09,50.97,111.87,"percent of total billed charges",null,"professional"]
["Avulsion Nail Plate Partial/Comp Simple Ea Addl","PX-11732","CDM",11732,"CPT",{"$nulls":8},"both",null,null,95.43,95.43,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,66.8,15.9,31.94,"percent of total billed charges",null,"professional"]
["Evacuation Subungual Hematoma","PX-11740","CDM",11740,"CPT",{"$nulls":8},"both",null,null,169.11,169.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,118.38,31.29,56.5,"percent of total billed charges",null,"professional"]
["Excision Nail Matrix Permanent Removal","PX-11750","CDM",11750,"CPT",{"$nulls":8},"both",null,null,467.55,467.55,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,327.29,98.14,156.43,"percent of total billed charges",null,"professional"]
["Repair Nail Bed","PX-11760","CDM",11760,"CPT",{"$nulls":8},"both",null,null,534.63,534.63,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,374.24,104.72,179.05,"percent of total billed charges",null,"professional"]
["Wedge Excision Skin Nail Fold","PX-11765","CDM",11765,"CPT",{"$nulls":8},"both",null,null,485.1,485.1,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,339.57,90.1,162.14,"percent of total billed charges",null,"professional"]
["Excision Pilonidal Cyst/Sinus Simple","PX-11770","CDM",11770,"CPT",{"$nulls":8},"both",null,null,1011.72,1011.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,708.2,173.88,339.89,"percent of total billed charges",null,"professional"]
["Gastric Intubat Dx W/Aspiration Single Specimen","PX-43754","CDM",43754,"CPT",{"$nulls":8},"both",null,null,684.51,684.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,479.16,35.75,228.61,"percent of total billed charges",null,"professional"]
["Excision Pilonidal Cyst/Sinus Extensive","PX-11771","CDM",11771,"CPT",{"$nulls":8},"both",null,null,1781.43,1781.43,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1247,423.83,600,"percent of total billed charges",null,"professional"]
["Excision Pilonidal Cyst/Sinus Complicated","PX-11772","CDM",11772,"CPT",{"$nulls":8},"both",null,null,2185.11,2185.11,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1529.58,547.1,735.7,"percent of total billed charges",null,"professional"]
["Injection Intralesional Up to & Includ 7 Lesions","PX-11900","CDM",11900,"CPT",{"$nulls":8},"both",null,null,166.29,166.29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,116.4,28.19,55.7,"percent of total billed charges",null,"professional"]
["Removal Implantable Contraceptive Capsules","PX-11976","CDM",11976,"CPT",{"$nulls":8},"both",null,null,411.06,411.06,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,287.74,85.96,138.35,"percent of total billed charges",null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Crvcl/Thora","PX-64633","CDM",64633,"CPT",{"$nulls":8},"both",null,null,5858.31,5858.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,890.63,182.89,425.53,"percent of total billed charges",null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Addl Crvcl/Thora","PX-64634","CDM",64634,"CPT",{"$nulls":8},"both",null,null,745.56,745.56,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,521.89,63.1,249.09,"percent of total billed charges",null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Sngl Lmbr/Sacral","PX-64635","CDM",64635,"CPT",{"$nulls":8},"both",null,null,5858.31,5858.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,898.19,183.22,429.13,"percent of total billed charges",null,"professional"]
["Dstr Nrolytc Agnt Parverteb Fct Addl Lmbr/Sacral","PX-64636","CDM",64636,"CPT",{"$nulls":8},"both",null,null,700.59,700.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,490.41,55.24,234.02,"percent of total billed charges",null,"professional"]
["Insertion Drug Delivery Implant","PX-11981","CDM",11981,"CPT",{"$nulls":8},"both",null,null,284.91,284.91,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,199.44,57.91,95.89,"percent of total billed charges",null,"professional"]
["Removal Non-Biodegradable Drug Delivery Implant","PX-11982","CDM",11982,"CPT",{"$nulls":8},"both",null,null,313.53,313.53,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,219.47,67.59,105.57,"percent of total billed charges",null,"professional"]
["Rmvl W/Rinsj Non-Biodegradable Drug Dlvr Implt","PX-11983","CDM",11983,"CPT",{"$nulls":8},"both",null,null,398.82,398.82,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,279.17,95.47,134.44,"percent of total billed charges",null,"professional"]
["Simple Repair Scalp/Neck/Ax/Genit/Trunk 2.5cm/<","PX-12001","CDM",12001,"CPT",{"$nulls":8},"both",null,null,269.28,269.28,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,188.5,41.35,90.46,"percent of total billed charges",null,"professional"]
["Smpl Repair Scalp/Neck/Ax/Genit/Trunk 2.6-7.5cm","PX-12002","CDM",12002,"CPT",{"$nulls":8},"both",null,null,324.57,324.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,227.2,54.15,109.16,"percent of total billed charges",null,"professional"]
["Simple Rpr Scalp/Neck/Ax/Genit/Trunk 7.6-12.5cm","PX-12004","CDM",12004,"CPT",{"$nulls":8},"both",null,null,376.32,376.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,263.42,67.45,126.72,"percent of total billed charges",null,"professional"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 12.6-20.0cm","PX-12005","CDM",12005,"CPT",{"$nulls":8},"both",null,null,500.28,500.28,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,350.2,86.34,168.53,"percent of total billed charges",null,"professional"]
["Smpl Rpr Scalp/Neck/Ax/Genit/Trunk 20.1-30.0cm","PX-12006","CDM",12006,"CPT",{"$nulls":8},"both",null,null,576.57,576.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,403.6,105.86,194.27,"percent of total billed charges",null,"professional"]
["Simple Repair F/E/E/N/L/M 2.5cm/<","PX-12011","CDM",12011,"CPT",{"$nulls":8},"both",null,null,319.29,319.29,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,223.5,51.03,107.35,"percent of total billed charges",null,"professional"]
["Simple Repair F/E/E/N/L/M 2.6cm-5.0 Cm","PX-12013","CDM",12013,"CPT",{"$nulls":8},"both",null,null,331.2,331.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,231.84,52.85,111.46,"percent of total billed charges",null,"professional"]
["Simple Repair F/E/E/N/L/M 5.1cm-7.5 Cm","PX-12014","CDM",12014,"CPT",{"$nulls":8},"both",null,null,402.96,402.96,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,282.07,68.29,135.74,"percent of total billed charges",null,"professional"]
["Simple Repair F/E/E/N/L/M 7.6cm-12.5 Cm","PX-12015","CDM",12015,"CPT",{"$nulls":8},"both",null,null,485.55,485.55,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,339.89,85.69,163.62,"percent of total billed charges",null,"professional"]
["Tx Superficial Wound Dehiscence Simple Closure","PX-12020","CDM",12020,"CPT",{"$nulls":8},"both",null,null,861.54,861.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,603.08,178.69,289.04,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E 2.5 Cm/<","PX-12031","CDM",12031,"CPT",{"$nulls":8},"both",null,null,761.85,761.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,533.3,144.7,255.05,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E 2.6-7.5 Cm","PX-12032","CDM",12032,"CPT",{"$nulls":8},"both",null,null,880.23,880.23,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,616.16,182.06,294.7,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E 7.6-12.5 Cm","PX-12034","CDM",12034,"CPT",{"$nulls":8},"both",null,null,964.92,964.92,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,675.44,195.05,323.41,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E 12.6-20.0cm","PX-12035","CDM",12035,"CPT",{"$nulls":8},"both",null,null,1112.07,1112.07,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,778.45,227.1,373.47,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E 20.1-30.0 Cm","PX-12036","CDM",12036,"CPT",{"$nulls":8},"both",null,null,1228.5,1228.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,859.95,263.43,413.39,"percent of total billed charges",null,"professional"]
["Repair Intermediate S/a/T/E >30.0 Cm","PX-12037","CDM",12037,"CPT",{"$nulls":8},"both",null,null,1375.74,1375.74,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,963.02,305.44,463.27,"percent of total billed charges",null,"professional"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.5cm/<","PX-12041","CDM",12041,"CPT",{"$nulls":8},"both",null,null,763.2,763.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,534.24,138.33,255.55,"percent of total billed charges",null,"professional"]
["Repair Intermediate N/H/F/Xtrnl Gent 2.6-7.5 Cm","PX-12042","CDM",12042,"CPT",{"$nulls":8},"both",null,null,896.49,896.49,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,627.54,186.66,300.28,"percent of total billed charges",null,"professional"]
["Repair Intermediate N/H/F/Xtrnl Gent 7.6-12.5cm","PX-12044","CDM",12044,"CPT",{"$nulls":8},"both",null,null,1103.34,1103.34,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,772.34,203.1,370.1,"percent of total billed charges",null,"professional"]
["Repair Intermediate N/H/F/Xtrnl Gent 12.6-20 Cm","PX-12045","CDM",12045,"CPT",{"$nulls":8},"both",null,null,1180.14,1180.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,826.1,258.24,396.43,"percent of total billed charges",null,"professional"]
["Rpr Intermediate N/H/F/Xtrnl Gent 20.1-30.0 Cm","PX-12046","CDM",12046,"CPT",{"$nulls":8},"both",null,null,1412.37,1412.37,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,988.66,295.98,475.74,"percent of total billed charges",null,"professional"]
["Repair Intermediate F/E/E/N/L&/Muc 2.5 Cm/<","PX-12051","CDM",12051,"CPT",{"$nulls":8},"both",null,null,819.09,819.09,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,573.36,161.44,274.41,"percent of total billed charges",null,"professional"]
["Repair Intermediate F/E/E/N/L&/Muc 2.6-5.0 Cm","PX-12052","CDM",12052,"CPT",{"$nulls":8},"both",null,null,910.98,910.98,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,637.69,189.95,305.21,"percent of total billed charges",null,"professional"]
["Repair Intermediate F/E/E/N/L&/Muc 5.1-7.5 Cm","PX-12053","CDM",12053,"CPT",{"$nulls":8},"both",null,null,1049.4,1049.4,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,734.58,204.55,351.57,"percent of total billed charges",null,"professional"]
["Repair Intermediate F/E/E/N/L&/Muc 7.6-12.5 Cm","PX-12054","CDM",12054,"CPT",{"$nulls":8},"both",null,null,1099.08,1099.08,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,769.36,207.56,368.66,"percent of total billed charges",null,"professional"]
["Repair Complex Trunk 1.1-2.5 Cm","PX-13100","CDM",13100,"CPT",{"$nulls":8},"both",null,null,981.84,981.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,687.29,189.8,328.96,"percent of total billed charges",null,"professional"]
["Repair Complex Trunk 2.6-7.5 Cm","PX-13101","CDM",13101,"CPT",{"$nulls":8},"both",null,null,1144.44,1144.44,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,801.11,234.35,383.34,"percent of total billed charges",null,"professional"]
["Repair Complex Scalp/Arm/Leg 1.1-2.5 Cm","PX-13120","CDM",13120,"CPT",{"$nulls":8},"both",null,null,1022.88,1022.88,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,716.02,219.94,342.73,"percent of total billed charges",null,"professional"]
["Repair Complex Scalp/Arm/Leg 2.6-7.5 Cm","PX-13121","CDM",13121,"CPT",{"$nulls":8},"both",null,null,1224.93,1224.93,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,857.45,244.04,410.38,"percent of total billed charges",null,"professional"]
["Repair Complex Scalp/Arm/Leg Ea Addl 5 Cm/<","PX-13122","CDM",13122,"CPT",{"$nulls":8},"both",null,null,359.94,359.94,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,251.96,76.74,120.95,"percent of total billed charges",null,"professional"]
["Repair Complex F/C/C/M/N/Ax/G/H/F 1.1-2.5 Cm","PX-13131","CDM",13131,"CPT",{"$nulls":8},"both",null,null,1116.48,1116.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,781.54,228.81,374.19,"percent of total billed charges",null,"professional"]
["Repair Complex F/C/C/M/N/Ax/G/H/F 2.6-7.5 Cm","PX-13132","CDM",13132,"CPT",{"$nulls":8},"both",null,null,1353.66,1353.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,947.56,286,453.65,"percent of total billed charges",null,"professional"]
["Repair Complex F/C/C/M/N/Ax/G/H/F Ea Addl 5 Cm/<","PX-13133","CDM",13133,"CPT",{"$nulls":8},"both",null,null,477.48,477.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,334.24,117.22,160.44,"percent of total billed charges",null,"professional"]
["Repair Complex Eyelid/Nose/Ear/Lip 1.1-2.5 Cm","PX-13151","CDM",13151,"CPT",{"$nulls":8},"both",null,null,1213.8,1213.8,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,849.66,262.58,406.98,"percent of total billed charges",null,"professional"]
["Repair Complex Eyelid/Nose/Ear/Lip 2.6-7.5 Cm","PX-13152","CDM",13152,"CPT",{"$nulls":8},"both",null,null,1423.59,1423.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,996.51,316.35,477.45,"percent of total billed charges",null,"professional"]
["Repair Complx Eyelid/Nose/Ear/Lip Ea Addl 5 Cm/<","PX-13153","CDM",13153,"CPT",{"$nulls":8},"both",null,null,521.76,521.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,365.23,126.76,175.55,"percent of total billed charges",null,"professional"]
["Adjt Tis Trnsfr/Reargmt Scalp/Arm/Leg 10 Sq Cm/<","PX-14020","CDM",14020,"CPT",{"$nulls":8},"both",null,null,2022.72,2022.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1415.9,542.01,678.88,"percent of total billed charges",null,"professional"]
["Adjt Tis Trns/Reargmt F/C/C/M/N/a/G/H/F 10sqcm/<","PX-14040","CDM",14040,"CPT",{"$nulls":8},"both",null,null,2183.49,2183.49,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1528.44,595.59,732.78,"percent of total billed charges",null,"professional"]
["Pinch Graft 1/Mlt Sm Ulcer Tip/Oth AR Up to 2 Cm","PX-15050","CDM",15050,"CPT",{"$nulls":8},"both",null,null,1674.45,1674.45,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1172.12,435.24,562.62,"percent of total billed charges",null,"professional"]
["Splt Agrft F/S/N/H/F/G/M/Dgt 1st 100 Sqcm/</1%","PX-15120","CDM",15120,"CPT",{"$nulls":8},"both",null,null,2399.61,2399.61,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1679.73,652.38,807.26,"percent of total billed charges",null,"professional"]
["PPPS, initial visit","PX-G0438","CDM","G0438","HCPCS",{"$nulls":8},"both",null,null,477.9,477.9,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,334.53,136.04,160.05,"percent of total billed charges",null,"professional"]
["PPPS, subseq visit","PX-G0439","CDM","G0439","HCPCS",{"$nulls":8},"both",null,null,376.2,376.2,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,263.34,107.07,125.97,"percent of total billed charges",null,"professional"]
["Penicillin g benzathine inj","PX-J0561","CDM","J0561","HCPCS",{"$nulls":8},"both",null,null,15,15,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,10.5,24.37,24.37,"percent of total billed charges",null,"professional"]
["Fluzone vacc, 3 yrs & >, im","PX-Q2038","CDM","Q2038","HCPCS",{"$nulls":8},"both",null,null,111.3,111.3,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,77.91,null,null,"percent of total billed charges",null,"professional"]
["Blepharoplasty Lower Eyelid","PX-15820","CDM",15820,"CPT",{"$nulls":8},"both",null,null,1683.42,1683.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1178.39,499.13,563.31,"percent of total billed charges",null,"professional"]
["Blepharoplasty Upper Eyelid","PX-15822","CDM",15822,"CPT",{"$nulls":8},"both",null,null,1334.85,1334.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,934.4,384.38,447.25,"percent of total billed charges",null,"professional"]
["Depression screen annual","PX-G0444","CDM","G0444","HCPCS",{"$nulls":8},"both",null,null,55.38,55.38,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,38.77,8.68,18.51,"percent of total billed charges",null,"professional"]
["Behavior counsel obesity 15m","PX-G0447","CDM","G0447","HCPCS",{"$nulls":8},"both",null,null,72.84,72.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,50.99,21.46,24.41,"percent of total billed charges",null,"professional"]
["Arthrocentesis Aspir&/Inj Interm Jt/Burs W/US","PX-20606","CDM",20606,"CPT",{"$nulls":8},"both",null,null,258.33,258.33,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,180.83,48.7,86.68,"percent of total billed charges",null,"professional"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/US","PX-20611","CDM",20611,"CPT",{"$nulls":8},"both",null,null,284.61,284.61,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,199.23,55.26,95.53,"percent of total billed charges",null,"professional"]
["Initial Tx 1st Degree Burn Local Tx","PX-16000","CDM",16000,"CPT",{"$nulls":8},"both",null,null,227.25,227.25,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,159.08,42.32,76.37,"percent of total billed charges",null,"professional"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Small","PX-16020","CDM",16020,"CPT",{"$nulls":8},"both",null,null,247.14,247.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,173,53.11,82.91,"percent of total billed charges",null,"professional"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Medium","PX-16025","CDM",16025,"CPT",{"$nulls":8},"both",null,null,448.02,448.02,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,313.61,104.78,150.62,"percent of total billed charges",null,"professional"]
["Drs&/Dbrdmt Prtl-Thkns Burns 1st/Sbsq Large","PX-16030","CDM",16030,"CPT",{"$nulls":8},"both",null,null,558,558,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,390.6,122.7,187.86,"percent of total billed charges",null,"professional"]
["Destruction Premalignant Lesion 1st","PX-17000","CDM",17000,"CPT",{"$nulls":8},"both",null,null,196.74,196.74,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,137.72,53.41,65.85,"percent of total billed charges",null,"professional"]
["Destruction Premalignant Lesion 2-14 Ea","PX-17003","CDM",17003,"CPT",{"$nulls":8},"both",null,null,19.65,19.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,13.76,1.96,5.57,"percent of total billed charges",null,"professional"]
["Destruction Premalignant Lesion 15/>","PX-17004","CDM",17004,"CPT",{"$nulls":8},"both",null,null,486,486,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,340.2,94.22,162.66,"percent of total billed charges",null,"professional"]
["Destruction Benign Lesions Up to 14","PX-17110","CDM",17110,"CPT",{"$nulls":8},"both",null,null,332.7,332.7,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,232.89,66.67,94.53,"percent of total billed charges",null,"professional"]
["Destruction Benign Lesions 15/>","PX-17111","CDM",17111,"CPT",{"$nulls":8},"both",null,null,387.84,387.84,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,271.49,80.61,129.72,"percent of total billed charges",null,"professional"]
["Chemical Cauterization of Granulation Tissue","PX-17250","CDM",17250,"CPT",{"$nulls":8},"both",null,null,252.51,252.51,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,176.76,35.74,84.52,"percent of total billed charges",null,"professional"]
["Colonoscopy Flx Ablation Tumor Polyp/Other Les","PX-45388","CDM",45388,"CPT",{"$nulls":8},"both",null,null,7083.63,7083.63,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,4958.54,251.01,2363.99,"percent of total billed charges",null,"professional"]
["Exploration Penetrating Wound Spx Extremity","PX-20103","CDM",20103,"CPT",{"$nulls":8},"both",null,null,1603.5,1603.5,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1122.45,323.59,539.05,"percent of total billed charges",null,"professional"]
["Removal Foreign Body Muscle/Tendon Sheath Simple","PX-20520","CDM",20520,"CPT",{"$nulls":8},"both",null,null,628.77,628.77,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,440.14,141.78,210.87,"percent of total billed charges",null,"professional"]
["Injection Therapeutic Carpal Tunnel","PX-20526","CDM",20526,"CPT",{"$nulls":8},"both",null,null,233.31,233.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,163.32,52.98,78.52,"percent of total billed charges",null,"professional"]
["Injection 1 Tendon Sheath/Ligament Aponeurosis","PX-20550","CDM",20550,"CPT",{"$nulls":8},"both",null,null,164.85,164.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,115.4,36.4,55.39,"percent of total billed charges",null,"professional"]
["Injection Single Tendon Origin/Insertion","PX-20551","CDM",20551,"CPT",{"$nulls":8},"both",null,null,164.49,164.49,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,115.14,36.23,55.22,"percent of total billed charges",null,"professional"]
["Injection Single/Mlt Trigger Point 1/2 Muscles","PX-20552","CDM",20552,"CPT",{"$nulls":8},"both",null,null,150.36,150.36,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,105.25,34.75,50.47,"percent of total billed charges",null,"professional"]
["Injection Single/Mlt Trigger Point 3/> Muscles","PX-20553","CDM",20553,"CPT",{"$nulls":8},"both",null,null,173.31,173.31,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,121.32,39.51,58.17,"percent of total billed charges",null,"professional"]
["Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O US","PX-20600","CDM",20600,"CPT",{"$nulls":8},"both",null,null,153.66,153.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,107.56,33.61,51.62,"percent of total billed charges",null,"professional"]
["Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O US","PX-20605","CDM",20605,"CPT",{"$nulls":8},"both",null,null,157.59,157.59,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,110.31,34.6,52.93,"percent of total billed charges",null,"professional"]
["Arthrocentesis Aspir&/Inj Major Jt/Bursa W/O US","PX-20610","CDM",20610,"CPT",{"$nulls":8},"both",null,null,184.65,184.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,129.26,42.48,62.12,"percent of total billed charges",null,"professional"]
["Aspiration&/Injection Ganglion Cyst Any Locatj","PX-20612","CDM",20612,"CPT",{"$nulls":8},"both",null,null,186.48,186.48,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,130.54,38.69,62.6,"percent of total billed charges",null,"professional"]
["9vhpv Vacc 2/3 Dose Sched Im Use","PX-90651","CDM",90651,"CPT",{"$nulls":8},"both",null,null,372,372,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,260.4,null,null,"percent of total billed charges",null,"professional"]
["Behav Assmt W/Score & Docd/Stand Instrument","PX-96127","CDM",96127,"CPT",{"$nulls":8},"both",null,null,13.14,13.14,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,9.2,4.43,4.43,"percent of total billed charges",null,"professional"]
["Chronic Care Mgmt Svcs Staff 1st 20 Min Cal Mo","PX-99490","CDM",99490,"CPT",{"$nulls":8},"both",null,null,180.42,180.42,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,126.29,47.68,60.45,"percent of total billed charges",null,"professional"]
["Advance Care Planning First 30 Mins","PX-99497","CDM",99497,"CPT",{"$nulls":8},"both",null,null,241.65,241.65,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,169.16,71.77,78.97,"percent of total billed charges",null,"professional"]
["4vhpv Vaccine 3 Dose Schedule for Im Use","PX-90649","CDM",90649,"CPT",{"$nulls":8},"both",null,null,349.94,349.94,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,244.96,null,null,"percent of total billed charges",null,"professional"]
["Td Vaccine Prsrv Free 7 Yrs or Older for Im Use","PX-90714","CDM",90714,"CPT",{"$nulls":8},"both",null,null,91.32,91.32,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,63.92,43.66,43.66,"percent of total billed charges",null,"professional"]
["Excision Tumor Soft Tissue Back/Flank Subq <3cm","PX-21930","CDM",21930,"CPT",{"$nulls":8},"both",null,null,1430.52,1430.52,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1001.36,346.38,481.61,"percent of total billed charges",null,"professional"]
["Cltx Prox Humrl Fx W/Mnpj W/WO Skeletal Tracj","PX-23605","CDM",23605,"CPT",{"$nulls":8},"both",null,null,1372.41,1372.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,960.69,417.58,462.11,"percent of total billed charges",null,"professional"]
["Cltx Greater Humeral Tuberosity Fx W/O Mnpj","PX-23620","CDM",23620,"CPT",{"$nulls":8},"both",null,null,805.62,805.62,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,563.93,258.96,270.75,"percent of total billed charges",null,"professional"]
["Clsd Tx Shoulder Dislc W/Manipulation W/O Anes","PX-23650","CDM",23650,"CPT",{"$nulls":8},"both",null,null,978.72,978.72,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,685.1,296.25,329.65,"percent of total billed charges",null,"professional"]
["Clsd Tx Shoulder Dislc W/Manipulation Req Anes","PX-23655","CDM",23655,"CPT",{"$nulls":8},"both",null,null,1178.85,1178.85,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,825.2,397.24,397.24,"percent of total billed charges",null,"professional"]
["Incision&Drainage Upper Arm/Elbow Bursa","PX-23931","CDM",23931,"CPT",{"$nulls":8},"both",null,null,878.55,878.55,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,614.99,155.57,294.4,"percent of total billed charges",null,"professional"]
["Excision Olecranon Bursa","PX-24105","CDM",24105,"CPT",{"$nulls":8},"both",null,null,1046.82,1046.82,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,732.77,352.25,352.25,"percent of total billed charges",null,"professional"]
["Exc/Curtg Bone Cyst/Benign Tumor H/N Rds/Olecrn","PX-24120","CDM",24120,"CPT",{"$nulls":8},"both",null,null,1520.22,1520.22,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1064.15,512.71,512.71,"percent of total billed charges",null,"professional"]
["Continuous Glucose Monitoring Analysis I&R","PX-95251","CDM",95251,"CPT",{"$nulls":8},"both",null,null,98.76,98.76,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,69.13,33.09,33.09,"percent of total billed charges",null,"professional"]
["Clsd Tx Humeral Shaft Fracture W/O Manipulation","PX-24500","CDM",24500,"CPT",{"$nulls":8},"both",null,null,1076.01,1076.01,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,753.21,332.25,361.72,"percent of total billed charges",null,"professional"]
["Cltx Humeral Shft Fx W/Manj W/WO Skeletal Tracj","PX-24505","CDM",24505,"CPT",{"$nulls":8},"both",null,null,1473.66,1473.66,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,1031.56,441.53,496.21,"percent of total billed charges",null,"professional"]
["Treatment Closed Elbow Dislocation W/O Anes","PX-24600","CDM",24600,"CPT",{"$nulls":8},"both",null,null,1101.93,1101.93,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,771.35,334.66,371.33,"percent of total billed charges",null,"professional"]
["Treatment Closed Elbow Dislocation Req Anes","PX-24605","CDM",24605,"CPT",{"$nulls":8},"both",null,null,1377.54,1377.54,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,964.28,464.3,464.3,"percent of total billed charges",null,"professional"]
["Cltx Rdl Head Sublxtj Chld Nursemaid Elbw W/Manj","PX-24640","CDM",24640,"CPT",{"$nulls":8},"both",null,null,304.95,304.95,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,213.47,77.82,102.05,"percent of total billed charges",null,"professional"]
["Closed Tx Radial Head/Neck Fx W/O Manipulation","PX-24650","CDM",24650,"CPT",{"$nulls":8},"both",null,null,789,789,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,552.3,246.32,264.99,"percent of total billed charges",null,"professional"]
["Closed Tx Ulnar Fracture Proximal End W/O Manj","PX-24670","CDM",24670,"CPT",{"$nulls":8},"both",null,null,870.57,870.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,609.4,266.67,292.54,"percent of total billed charges",null,"professional"]
["Closed Tx Ulnar Fracture Proximal End W/Manj","PX-24675","CDM",24675,"CPT",{"$nulls":8},"both",null,null,1347.57,1347.57,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,943.3,409.03,453.57,"percent of total billed charges",null,"professional"]
["Excision Ganglion Wrist Dorsal/Volar Primary","PX-25111","CDM",25111,"CPT",{"$nulls":8},"both",null,null,944.97,944.97,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,661.48,318,318,"percent of total billed charges",null,"professional"]
["Closed Tx Radial Shaft Fracture W/O Manipulation","PX-25500","CDM",25500,"CPT",{"$nulls":8},"both",null,null,849.81,849.81,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,594.87,257.65,285.48,"percent of total billed charges",null,"professional"]
["Closed Tx Radial&Ulnar Shaft Fractures W/O Mnpj","PX-25560","CDM",25560,"CPT",{"$nulls":8},"both",null,null,865.89,865.89,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,606.12,258.8,290.89,"percent of total billed charges",null,"professional"]
["Cltx Dstl Radial Fx/Epiphysl Sep W/O Mnpj","PX-25600","CDM",25600,"CPT",{"$nulls":8},"both",null,null,1012.41,1012.41,"ABLEPAY [1043]","ABLEPAY HEALTH [919]",null,null,70,null,708.69,324.8,339.86,"percent of total billed charges",null,"professional"]