Assoc Cost Center Desc (2401 DESC) Procedure Master # (100)

Procedure Name (2) Charge Type Billing Category (2440) Status A/I (60) Default Rev Code (550)

CPT Code (2000)

Unit Charge (210)

Covid-19 Amp Probe-LAB CORP 87635 $128.25CC WCB ASSISTED LIVING 12010100 HC R&B ASSISTED LIVING DAILY CHG- PROCEDURE Room & Board ACTIVE 0120 12010100 $0.00CC WCB ASSISTED LIVING 12010101 HC R&B DSHS BED HOLD PROCEDURE Room & Board ACTIVE 0120 12010101 $48.60CC WCB ASSISTED LIVING 12010102 HC R&B ALF ADD-ON DOUBLE ROOM 1 RESID PROCEDURE Room & Board ACTIVE 0120 12010102 $100.00CC WCB ASSISTED LIVING 12010103 HC R&B ALF ADD-ON LEVEL 2 PROCEDURE Room & Board ACTIVE 0120 12010103 $300.00CC WCB ASSISTED LIVING 12010104 HC R&B ALF ADD ON - LEVEL 3 PROCEDURE Room & Board ACTIVE 0120 12010104 $700.00CC WCB ASSISTED LIVING 12010105 HC R&B ALF ADD ON - ADDL PERSON PROCEDURE Room & Board ACTIVE 0120 12010105 $770.00CC WCB ASSISTED LIVING 12010106 HC R&B ALF ADD ON - LEVEL 4 PROCEDURE Room & Board ACTIVE 0120 12010106 $1,500.00CC WCB ASSISTED LIVING 12010107 HC R&B ALF-MONTHLY BASE ROOM CHG PROCEDURE Room & Board ACTIVE 0120 12010107 $3,115.00CC WCB ASSISTED LIVING 18010001 HC LEAVE OF ABSENCE NO CHRG PROCEDURE Room & Board ACTIVE 0180 18010001 $0.00CC WCB ASSISTED LIVING 99010117 HC RETURN CHECK FEE PROCEDURE STATS ONLY ACTIVE 0990 99010117 $40.80CC WCB ASSISTED LIVING 99010238 HC ALF CLEANING FEE PROCEDURE Room & Board ACTIVE 0990 99010238 $75.00CC WCB BLOOD BANK 30210874 HC PLASMA FRESH FROZEN PROCEDURE LAB ACTIVE 0300 86927 $459.00CC WCB BLOOD BANK 39010002 HC CRYOPRECIPITATE EACH UNIT PROCEDURE LAB ACTIVE 0390 P9012 $65.28CC WCB BLOOD BANK 39010015 HC RBC LEUKOREDUCED PROCEDURE LAB ACTIVE 0390 P9016 $219.30CC WCB BLOOD BANK 39010033 HC PLATELET PHERESIS LEUKOREDU IRRAD PROCEDURE LAB ACTIVE 0390 P9037 $601.80CC WCB BLOOD BANK 39010036 HC CRYOPRECIPITATE REDUCED PLASMA PROCEDURE LAB ACTIVE 0390 P9044 $432.48CC WCB BLOOD BANK 39010045 HC FRESH FROZEN PLASMA FRZ BETWEEN 8-24HOUR PROCEDURE LAB ACTIVE 0390 P9059 $90.78CC WCB CT 35010006 HC CT MAXILLOFACIAL/SINUS W/O & W/DYE PROCEDURE IMAGING ACTIVE 0350 70488 $1,834.32CC WCB CT 35010007 HC CT SOFT TISSUE NECK W/O DYE PROCEDURE IMAGING ACTIVE 0350 70490 $1,392.91CC WCB CT 35010008 HC CT SOFT TISSUE NECK W/DYE PROCEDURE IMAGING ACTIVE 0350 70491 $1,537.70CC WCB CT 35010009 HC CT SFT TSUE NCK W/O & W/DYE PROCEDURE IMAGING ACTIVE 0350 70492 $1,852.47CC WCB CT 35010010 HC CT ANGIOGRAPHY NECK W/ AND W/O DYE PROCEDURE IMAGING ACTIVE 0350 70498 $2,384.20CC WCB CT 35010011 HC CT THORAX W/O DYE PROCEDURE IMAGING ACTIVE 0350 71250 $1,479.61CC WCB CT 35010013 HC CT ANGIOGRAPHY CHEST PROCEDURE IMAGING ACTIVE 0350 71275 $2,491.91CC WCB CT 35010018 HC CT LWR EXTREMITY W/O&W/DYE PROCEDURE IMAGING ACTIVE 0350 73702 $1,465.84CC WCB CT 35010020 HC CT ANGIO LWR EXTR W/O&W/DYE PROCEDURE IMAGING ACTIVE 0350 73706 $1,855.79CC WCB CT 35010023 HC CT ANGIO ABDOMEN W/O & W/DYE PROCEDURE IMAGING ACTIVE 0350 74175 $2,383.18CC WCB CT 35010024 HC CT ABD & PELVIS W/O CONTRAST PROCEDURE IMAGING ACTIVE 0350 74176 $1,137.66CC WCB CT 35010025 HC CT ABDOMEN & PELVIS W/ DYE PROCEDURE IMAGING ACTIVE 0350 74177 $1,743.08CC WCB CT 35010031 HC CT ANGIO ABDOMINAL ARTERIES PROCEDURE IMAGING ACTIVE 0350 75635 $3,608.96CC WCB CT 35010032 HC 3D RENDER W/O POSTPROCESS PROCEDURE IMAGING ACTIVE 0350 76376 $638.93CC WCB CT 35010072 HC CT ANGIO ABDOMEN PELVIS PROCEDURE IMAGING ACTIVE 0350 74174 $2,946.42CC WCB CT 35110002 HC CT HEAD/BRAIN W/O DYE PROCEDURE IMAGING ACTIVE 0351 70450 $1,230.17CC WCB CT 35110007 HC CT HEAD/BRAIN W/DYE PROCEDURE IMAGING ACTIVE 0351 70460 $1,468.90CC WCB CT 35110012 HC CT HEAD/BRAIN W/O & W/DYE PROCEDURE IMAGING ACTIVE 0351 70470 $1,827.08CC WCB CT 35110014 HC CT ORBIT/EAR/FOSSA W/O DYE PROCEDURE IMAGING ACTIVE 0351 70480 $1,411.07CC WCB CT 35110017 HC CT ORBIT/EAR/FOSSA W/DYE PROCEDURE IMAGING ACTIVE 0351 70481 $1,555.76CC WCB CT 35110019 HC CT ORBIT/EAR/FOSSA W/O&W/DYE PROCEDURE IMAGING ACTIVE 0351 70482 $1,863.34CC WCB CT 35110022 HC CT MAXILLOFACIAL W/O DYE PROCEDURE IMAGING ACTIVE 0350 70486 $1,338.70CC WCB CT 35110030 HC CT MAXILLOFACIAL W/DYE PROCEDURE IMAGING ACTIVE 0351 70487 $1,519.60CC WCB CT 35110032 HC CT ANGIOGRAPHY HEAD PROCEDURE IMAGING ACTIVE 0351 70496 $2,387.67CC WCB CT 35210003 HC CT THORAX W/DYE PROCEDURE IMAGING ACTIVE 0352 71260 $1,635.37CC WCB CT 35210006 HC CT THORAX W/O & W/DYE PROCEDURE IMAGING ACTIVE 0352 71270 $2,024.70CC WCB CT 35210008 HC CT NECK SPINE W/O DYE PROCEDURE IMAGING ACTIVE 0352 72125 $1,531.99CC WCB CT 35210009 HC CT NECK SPINE W/DYE PROCEDURE IMAGING ACTIVE 0352 72126 $1,806.27CC WCB CT 35210010 HC CT NECK SPINE W/O & W/DYE PROCEDURE IMAGING ACTIVE 0352 72127 $2,285.31CC WCB CT 35210011 HC CT CHEST SPINE W/O DYE PROCEDURE IMAGING ACTIVE 0352 72128 $1,528.67CC WCB CT 35210012 HC CT CHEST SPINE W/DYE PROCEDURE IMAGING ACTIVE 0352 72129 $1,789.54CC WCB CT 35210013 HC CT CHEST SPINE W/O & W/DYE PROCEDURE IMAGING ACTIVE 0352 72130 $2,250.07CC WCB CT 35210014 HC CT LUMBAR SPINE W/O DYE PROCEDURE IMAGING ACTIVE 0352 72131 $1,521.99CC WCB CT 35210015 HC CT LUMBAR SPINE W/DYE PROCEDURE IMAGING ACTIVE 0352 72132 $1,756.03CC WCB CT 35210016 HC CT LUMBAR SPINE W/O & W/DYE PROCEDURE IMAGING ACTIVE 0352 72133 $2,179.84

CC WCB CT 35210017 HC CT ANGIOGRAPH PELV W/O&W/DYE PROCEDURE IMAGING ACTIVE 0352 72191 $2,368.19CC WCB CT 35210018 HC CT PELVIS W/O DYE PROCEDURE IMAGING ACTIVE 0352 72192 $1,338.04CC WCB CT 35210020 HC CT PELVIS W/DYE PROCEDURE IMAGING ACTIVE 0352 72193 $1,538.67CC WCB CT 35210024 HC CT PELVIS W/O & W/DYE PROCEDURE IMAGING ACTIVE 0352 72194 $1,839.67CC WCB CT 35210029 HC CT UPPER EXTREMITY W/O DYE PROCEDURE IMAGING ACTIVE 0350 73200 $1,106.34CC WCB CT 35210030 HC CT LOWER EXTREMITY W/O DYE PROCEDURE IMAGING ACTIVE 0350 73700 $1,049.02CC WCB CT 35210031 HC CT UPPER EXTREMITY W/DYE PROCEDURE IMAGING ACTIVE 0352 73201 $1,244.66CC WCB CT 35210034 HC CT UPPR EXTREMITY W/O&W/DYE PROCEDURE IMAGING ACTIVE 0350 73202 $1,452.02CC WCB CT 35210037 HC CT ANGIO UPR EXTRM W/O&W/DYE PROCEDURE IMAGING ACTIVE 0352 73206 $1,963.65CC WCB CT 35210038 HC CT ABDOMEN W/O DYE PROCEDURE IMAGING ACTIVE 0352 74150 $1,397.15CC WCB CT 35210040 HC CT LOWER EXTREMITY W/DYE PROCEDURE IMAGING ACTIVE 0352 73701 $1,156.48CC WCB CT 35210046 HC CT ABDOMEN W/DYE PROCEDURE IMAGING ACTIVE 0352 74160 $1,643.53CC WCB CT 35210047 HC CT ABDOMEN W/O & W/DYE PROCEDURE IMAGING ACTIVE 0352 74170 $1,972.32CC WCB CT 35210054 HC CT ABDOMEN & PELVIS W/WO DYE PROCEDURE IMAGING ACTIVE 0352 74178 $2,275.11CC WCB DIAGNOSTIC IMAGING 002475WCB HC .9 NACL 250ML - IRRIG SOLUTION SUPPLY Supplies ACTIVE 0270 002475WCB $24.48CC WCB DIAGNOSTIC IMAGING 002648WCB HC MEPILEX 6 X 6 DRESSING SUPPLY Supplies ACTIVE 0270 002648WCB $46.10CC WCB DIAGNOSTIC IMAGING 003063WCB HC NEEDLE EZ 10 15 GM 45 MM SUPPLY Supplies ACTIVE 0270 003063WCB $218.18CC WCB DIAGNOSTIC IMAGING 003177WCB HC DRESSING-AQUACEL AG SURGICAL SUPPLY Supplies ACTIVE 0270 003177WCB $231.08CC WCB DIAGNOSTIC IMAGING 32010003 HC XR EYE FOR FOREIGN BODY PROCEDURE IMAGING ACTIVE 0320 70030 $227.15CC WCB DIAGNOSTIC IMAGING 32010004 HC XR TOES(S) 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73660 $115.06CC WCB DIAGNOSTIC IMAGING 32010006 HC XR JAW 1-3 VIEWS PROCEDURE IMAGING ACTIVE 0320 70100 $119.60CC WCB DIAGNOSTIC IMAGING 32010007 HC XR JAW 4+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70110 $172.84CC WCB DIAGNOSTIC IMAGING 32010008 HC XR MASTOIDS 1-2 VIEWS PROCEDURE IMAGING ACTIVE 0320 70120 $130.41CC WCB DIAGNOSTIC IMAGING 32010009 HC XR MASTOIDS 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70130 $217.92CC WCB DIAGNOSTIC IMAGING 32010010 HC XR INTERNAL AUDITORY CANAL PROCEDURE IMAGING ACTIVE 0320 70134 $180.80CC WCB DIAGNOSTIC IMAGING 32010011 HC XR FACIAL BONES 1-2 VIEWS PROCEDURE IMAGING ACTIVE 0320 70140 $159.58CC WCB DIAGNOSTIC IMAGING 32010012 HC XR FACIAL BONES 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70150 $196.71CC WCB DIAGNOSTIC IMAGING 32010014 HC XR NASAL BONES 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70160 $116.94CC WCB DIAGNOSTIC IMAGING 32010016 HC XR OPTIC FORAMINA PROCEDURE IMAGING ACTIVE 0320 70190 $156.77CC WCB DIAGNOSTIC IMAGING 32010017 HC XR ORBITS 4+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70200 $199.41CC WCB DIAGNOSTIC IMAGING 32010018 HC XR SINUSES 1-2 VIEWS PROCEDURE IMAGING ACTIVE 0320 70210 $133.01CC WCB DIAGNOSTIC IMAGING 32010020 HC XR SINUSES 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70220 $225.98CC WCB DIAGNOSTIC IMAGING 32010022 HC XR SKULL 1-3 VIEWS PROCEDURE IMAGING ACTIVE 0320 70250 $159.58CC WCB DIAGNOSTIC IMAGING 32010023 HC XR SKULL 4+ VIEWS PROCEDURE IMAGING ACTIVE 0320 70260 $225.98CC WCB DIAGNOSTIC IMAGING 32010027 HC XR JAW JOINT PROCEDURE IMAGING ACTIVE 0320 70328 $164.83CC WCB DIAGNOSTIC IMAGING 32010028 HC XR JAW JOINT BILAT PROCEDURE IMAGING ACTIVE 0320 70330 $239.24CC WCB DIAGNOSTIC IMAGING 32010029 HC XR EXAM ABDOMEN 1 VIEW PROCEDURE IMAGING ACTIVE 0320 74018CC WCB DIAGNOSTIC IMAGING 32010031 HC XR NECK SOFT TISSUE PROCEDURE IMAGING ACTIVE 0320 70360 $133.01CC WCB DIAGNOSTIC IMAGING 32010045 HC XR RIBS 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 71100 $171.97CC WCB DIAGNOSTIC IMAGING 32010046 HC XR RIBS/CHEST PROCEDURE IMAGING ACTIVE 0320 71101 $202.06CC WCB DIAGNOSTIC IMAGING 32010048 HC XR RIBS BILAT PROCEDURE IMAGING ACTIVE 0320 71110 $226.19CC WCB DIAGNOSTIC IMAGING 32010049 HC XR RIBS/CHEST BILAT PROCEDURE IMAGING ACTIVE 0320 71111 $254.13CC WCB DIAGNOSTIC IMAGING 32010050 HC XR STERNUM PROCEDURE IMAGING ACTIVE 0320 71120 $176.46CC WCB DIAGNOSTIC IMAGING 32010051 HC XR STERNO-CLAVICULAR JOINTS PROCEDURE IMAGING ACTIVE 0320 71130 $196.04CC WCB DIAGNOSTIC IMAGING 32010053 HC XR SPINE 1 VIEW ANY LEVEL PROCEDURE IMAGING ACTIVE 0320 72020 $117.71CC WCB DIAGNOSTIC IMAGING 32010055 HC XR CERVICAL SPINE 2 OR 3 VIEWS PROCEDURE IMAGING ACTIVE 0320 72040 $169.58CC WCB DIAGNOSTIC IMAGING 32010056 HC XR CERVICAL SPINE 4 OR 5 VIEWS PROCEDURE IMAGING ACTIVE 0320 72050 $238.12CC WCB DIAGNOSTIC IMAGING 32010057 HC XR CERVICAL SPINE 6 OR MORE VIEWS PROCEDURE IMAGING ACTIVE 0320 72052 $280.09CC WCB DIAGNOSTIC IMAGING 32010059 HC XR SPINE 2 VIEWS THORACIC PROCEDURE IMAGING ACTIVE 0320 72070 $170.90CC WCB DIAGNOSTIC IMAGING 32010060 HC XR SPINE 3 VIEWS THORACIC PROCEDURE IMAGING ACTIVE 0320 72072 $196.10CC WCB DIAGNOSTIC IMAGING 32010062 HC XR SPINE 2 VIEWS THORACO-LUMBAR PROCEDURE IMAGING ACTIVE 0320 72080 $184.82CC WCB DIAGNOSTIC IMAGING 32010065 HC XR SPINE 2-3 VIEWS LUMBAR PROCEDURE IMAGING ACTIVE 0320 72100 $173.66CC WCB DIAGNOSTIC IMAGING 32010066 HC XR SPINE 4+ VIEWS LUMBAR PROCEDURE IMAGING ACTIVE 0320 72110 $252.04CC WCB DIAGNOSTIC IMAGING 32010068 HC XR SPINE 2-3 VIEWS LUMBAR BEND ONLY PROCEDURE IMAGING ACTIVE 0320 72120 $308.14CC WCB DIAGNOSTIC IMAGING 32010069 HC XR PELVIS 1-2 VIEWS PROCEDURE IMAGING ACTIVE 0320 72170 $179.27

CC WCB DIAGNOSTIC IMAGING 32010072 HC XR PELVIS 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 72190 $224.04CC WCB DIAGNOSTIC IMAGING 32010073 HC XR SACROILIAC JOINTS 1-2 VIEWS PROCEDURE IMAGING ACTIVE 0320 72200 $168.96CC WCB DIAGNOSTIC IMAGING 32010074 HC XR SACROILIAC JOINTS 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 72202 $213.79CC WCB DIAGNOSTIC IMAGING 32010075 HC XR TAILBONE 2+ VIEWS PROCEDURE IMAGING ACTIVE 0320 72220 $189.52CC WCB DIAGNOSTIC IMAGING 32010085 HC XR CLAVICLE UNILAT PROCEDURE IMAGING ACTIVE 0320 73000 $141.73CC WCB DIAGNOSTIC IMAGING 32010088 HC XR HEEL 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73650 $122.86CC WCB DIAGNOSTIC IMAGING 32010089 HC XR SCAPULA PROCEDURE IMAGING ACTIVE 0320 73010 $161.93CC WCB DIAGNOSTIC IMAGING 32010091 HC XR FOOT 3 VIEWS PROCEDURE IMAGING ACTIVE 0320 73630 $141.17CC WCB DIAGNOSTIC IMAGING 32010092 HC XR SHOULDER 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73020 $121.48CC WCB DIAGNOSTIC IMAGING 32010099 HC XR SHOULDER ACROMIO-CLAVICULAR JOINTS PROCEDURE IMAGING ACTIVE 0320 73050 $179.16CC WCB DIAGNOSTIC IMAGING 32010101 HC XR HUMERUS 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73060 $159.07CC WCB DIAGNOSTIC IMAGING 32010105 HC XR ELBOW 2 VIEW PROCEDURE IMAGING ACTIVE 0320 73070 $133.06CC WCB DIAGNOSTIC IMAGING 32010106 HC XR ELBOW 3 VIEWS PROCEDURE IMAGING ACTIVE 0320 73080 $153.26CC WCB DIAGNOSTIC IMAGING 32010107 HC XR EXAM ABDOMEN 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 74019 $187.48CC WCB DIAGNOSTIC IMAGING 32010112 HC XR FOREARM 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73090CC WCB DIAGNOSTIC IMAGING 32010115 HC XR ARM INFANT PROCEDURE IMAGING ACTIVE 0320 73092 $130.05CC WCB DIAGNOSTIC IMAGING 32010117 HC XR WRIST 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73100 $127.25CC WCB DIAGNOSTIC IMAGING 32010118 HC XR WRIST 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73100 $127.25CC WCB DIAGNOSTIC IMAGING 32010119 HC XR WRIST 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 73110 $145.86CC WCB DIAGNOSTIC IMAGING 32010125 HC XR HAND 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73120 $124.34CC WCB DIAGNOSTIC IMAGING 32010129 HC XR HAND 3+ VIEWS PROCEDURE IMAGING ACTIVE 0320 73130 $144.53CC WCB DIAGNOSTIC IMAGING 32010131 HC XR FINGERS(S) 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73140 $107.00CC WCB DIAGNOSTIC IMAGING 32010149 HC XR KNEE 1-2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73560 $137.24CC WCB DIAGNOSTIC IMAGING 32010152 HC XR KNEE 3 VIEWS PROCEDURE IMAGING ACTIVE 0320 73562 $154.28CC WCB DIAGNOSTIC IMAGING 32010154 HC XR KNEE 4+ VIEWS PROCEDURE IMAGING ACTIVE 0320 73564 $182.84CC WCB DIAGNOSTIC IMAGING 32010156 HC XR KNEES STANDING BILAT PROCEDURE IMAGING ACTIVE 0320 73565 $133.31CC WCB DIAGNOSTIC IMAGING 32010159 HC XR LOWER LEG PROCEDURE IMAGING ACTIVE 0320 73590 $135.92CC WCB DIAGNOSTIC IMAGING 32010161 HC XR LEG INFANT PROCEDURE IMAGING ACTIVE 0320 73592 $128.11CC WCB DIAGNOSTIC IMAGING 32010163 HC XR ANKLE 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73600 $126.74CC WCB DIAGNOSTIC IMAGING 32010165 HC XR ANKLE 3 VIEWS PROCEDURE IMAGING ACTIVE 0320 73610 $143.77CC WCB DIAGNOSTIC IMAGING 32010175 HC XR ABDOMEN SERIES PROCEDURE IMAGING ACTIVE 0320 74022 $241.54CC WCB DIAGNOSTIC IMAGING 32010190 HC XR ABDOMEN PORTABLE 1 VIEW PROCEDURE IMAGING ACTIVE 0320 74018 $155.09CC WCB DIAGNOSTIC IMAGING 32010320 HC XR PEDIATRIC FOREIGN BODY 1 VW PROCEDURE IMAGING ACTIVE 0320 76010 $193.34CC WCB DIAGNOSTIC IMAGING 32010341 HC XR BONE SURVEY COMPLETE PROCEDURE IMAGING ACTIVE 0320 77075 $461.96CC WCB DIAGNOSTIC IMAGING 32010343 HC XR JOINT SURVEY 1 VIEW PROCEDURE IMAGING ACTIVE 0320 77077 $199.05CC WCB DIAGNOSTIC IMAGING 32010481 HC XR SHOULDER 2+ VIEWS COMPLETE PROCEDURE IMAGING ACTIVE 0320 73030 $173.76CC WCB DIAGNOSTIC IMAGING 32010483 HC XR FOREARM 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73090 $135.92CC WCB DIAGNOSTIC IMAGING 32010503 HC XR ANKLE 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73600 $126.74CC WCB DIAGNOSTIC IMAGING 32010505 HC XR FOOT 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73620 $125.51CC WCB DIAGNOSTIC IMAGING 32010604 HC XR ENTIRE SPINE 1 VW PROCEDURE IMAGING ACTIVE 0320 72081 $144.13CC WCB DIAGNOSTIC IMAGING 32010605 HC XR ENTIRE SPINE 2-3 VW PROCEDURE IMAGING ACTIVE 0320 72082 $207.52CC WCB DIAGNOSTIC IMAGING 32010606 HC XR ENTIRE SPINE 4-5 VW PROCEDURE IMAGING ACTIVE 0320 72083 $360.11CC WCB DIAGNOSTIC IMAGING 32010607 HC XR ENTIRE SPINE 6/> VW PROCEDURE IMAGING ACTIVE 0320 72084 $377.25CC WCB DIAGNOSTIC IMAGING 32010608 HC RADEX HIP UNILATERAL WITH PELVIS 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73501 $158.81CC WCB DIAGNOSTIC IMAGING 32010609 HC RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS PROCEDURE IMAGING ACTIVE 0320 73502 $197.98CC WCB DIAGNOSTIC IMAGING 32010610 HC RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS PROCEDURE IMAGING ACTIVE 0320 73503 $228.94CC WCB DIAGNOSTIC IMAGING 32010611 HC XR HIPS BIL 2 VIEWS PROCEDURE IMAGING ACTIVE 0320 73521 $239.39CC WCB DIAGNOSTIC IMAGING 32010612 HC XR HIPS BIL 3-4 VIEWS PROCEDURE IMAGING ACTIVE 0320 73522 $283.41CC WCB DIAGNOSTIC IMAGING 32010613 HC XR HIPS BIL 5/> VIEWS PROCEDURE IMAGING ACTIVE 0320 73523 $328.24CC WCB DIAGNOSTIC IMAGING 32010614 HC XR FEMUR 1 VIEW PROCEDURE IMAGING ACTIVE 0320 73551 $156.62CC WCB DIAGNOSTIC IMAGING 32010615 HC XR FEMUR 2/> VIEWS PROCEDURE IMAGING ACTIVE 0320 73552 $185.18CC WCB DIAGNOSTIC IMAGING 32410014 HC XR EXAM CHEST 1 VIEW PROCEDURE IMAGING ACTIVE 0324 71045 $43.91CC WCB DIAGNOSTIC IMAGING 32410015 HC XR EXAM CHEST 2 VIEWS PROCEDURE IMAGING ACTIVE 0324 71046 $174.93CC WCB DIAGNOSTIC IMAGING 32410016 HC XR EXAM CHEST 3 VIEWS PROCEDURE IMAGING ACTIVE 0324 71047 $214.05CC WCB DIAGNOSTIC IMAGING 32410017 HC XR EXAM CHEST 4+ VIEWS PROCEDURE IMAGING ACTIVE 0324 71048 $101.49

CC WCB DIAGNOSTIC IMAGING 32410018 HC XR CHEST PORTABLE 1 VIEW PROCEDURE IMAGING ACTIVE 0324 71045 $135.81CC WCB DIAGNOSTIC IMAGING 34110047 HC NM BONE AND OR JOINT IMAGING LIMITED AREA CDM PROCEDURE IMAGING ACTIVE 0341 78300 $841.09CC WCB DIAGNOSTIC IMAGING 35010117 HC LDCT FOR LUNG CA SCREEN PROCEDURE IMAGING ACTIVE 0350 G0297 $752.20CC WCB DIAGNOSTIC IMAGING 40110004 HC MAMMO DIAG BILAT INCL CAD PROCEDURE IMAGING ACTIVE 0401 77066 $421.87CC WCB DIAGNOSTIC IMAGING 40110005 HC MAMMO DIAG UNILAT INCL CAD PROCEDURE IMAGING ACTIVE 0401 77065 $344.96CC WCB DIAGNOSTIC IMAGING 40210004 HC US EXAM OF HEAD AND NECK PROCEDURE IMAGING ACTIVE 0402 76536 $399.33CC WCB DIAGNOSTIC IMAGING 40210005 HC US EXAM CHEST PROCEDURE IMAGING ACTIVE 0402 76604 $482.15CC WCB DIAGNOSTIC IMAGING 40210008 HC US EXAM ABDOMEN COMPLETE PROCEDURE IMAGING ACTIVE 0402 76700 $566.30CC WCB DIAGNOSTIC IMAGING 40210010 HC US RETROPERITONEAL COMPLETE PROCEDURE IMAGING ACTIVE 0402 76770 $540.86CC WCB DIAGNOSTIC IMAGING 40210011 HC US RETROPERITONEAL LIMITED PROCEDURE IMAGING ACTIVE 0402 76775 $206.60CC WCB DIAGNOSTIC IMAGING 40210014 HC US OB < 14 WKS SINGLE FETUS PROCEDURE IMAGING ACTIVE 0402 76801 $481.34CC WCB DIAGNOSTIC IMAGING 40210015 HC US OB < 14 WKS ADDL FETUS PROCEDURE IMAGING ACTIVE 0402 76802 $272.14CC WCB DIAGNOSTIC IMAGING 40210016 HC US OB >= 14 WKS SINGLE FETUS PROCEDURE IMAGING ACTIVE 0402 76805 $454.97CC WCB DIAGNOSTIC IMAGING 40210017 HC US OB>= 14 WKS ADDL FETUS PROCEDURE IMAGING ACTIVE 0402 76810 $241.13CC WCB DIAGNOSTIC IMAGING 40210018 HC US OB DETAILED SINGLE FETUS PROCEDURE IMAGING ACTIVE 0402 76811 $815.90CC WCB DIAGNOSTIC IMAGING 40210019 HC US OB DETAILED ADDL FETUS PROCEDURE IMAGING ACTIVE 0402 76812 $516.78CC WCB DIAGNOSTIC IMAGING 40210022 HC US OB LIMITED FETUS(S) PROCEDURE IMAGING ACTIVE 0402 76815 $331.65CC WCB DIAGNOSTIC IMAGING 40210023 HC US OB FOLLOW-UP PER FETUS PROCEDURE IMAGING ACTIVE 0402 76816 $312.83CC WCB DIAGNOSTIC IMAGING 40210024 HC US OB TRANSVAGINAL PROCEDURE IMAGING ACTIVE 0402 76817 $385.66CC WCB DIAGNOSTIC IMAGING 40210026 HC US FETAL BIOPHYS PROFILE W/O NST PROCEDURE IMAGING ACTIVE 0402 76819 $437.02CC WCB DIAGNOSTIC IMAGING 40210033 HC US TRANSVAGINAL NON-OB PROCEDURE IMAGING ACTIVE 0402 76830 $514.18CC WCB DIAGNOSTIC IMAGING 40210035 HC US EXAM PELVIC FOLLICLE LIMITED PROCEDURE IMAGING ACTIVE 0402 76857 $411.26CC WCB DIAGNOSTIC IMAGING 40210036 HC US EXAM SCROTUM & CONTENTS PROCEDURE IMAGING ACTIVE 0402 76870 $385.66CC WCB DIAGNOSTIC IMAGING 40210049 HC US GUIDE VASCULAR ACCESS PROCEDURE IMAGING ACTIVE 0402 76937 $70.58CC WCB DIAGNOSTIC IMAGING 40210093 HC US EXAM PELVIC COMPLETE PROCEDURE IMAGING ACTIVE 0402 76856 $449.82CC WCB DIAGNOSTIC IMAGING 40210104 HC US EXAM OF ABDOMEN LIMITED PROCEDURE IMAGING ACTIVE 0402 76705 $404.89CC WCB DIAGNOSTIC IMAGING 40210112 HC US EXT NON-VASC AXILLA LIMITED PROCEDURE IMAGING ACTIVE 0402 76882 $146.88CC WCB DIAGNOSTIC IMAGING 40210142 HC US ABD AORTA SCRN AAA PROCEDURE IMAGING ACTIVE 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MATERIAPROCEDURE IMAGING-Profees ACTIVE 0972 73722 $466.45CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210213 HC PR 73721 MRI ANY JT LOWER EXTREM W/O CONTRAST MATRLPROCEDURE IMAGING-Profees ACTIVE 0972 73721 $388.37CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210214 HC PR 73720 MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR PROCEDURE IMAGING-Profees ACTIVE 0972 73720 $618.32CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210215 HC PR 73220 MRI UPPER EXTREM OTHER THAN JT W/O & W/CON PROCEDURE IMAGING-Profees ACTIVE 0972 73220 $620.42CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210216 HC PR 73223 MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MAPROCEDURE IMAGING-Profees ACTIVE 0972 73223 $620.42CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210217 HC PR 73222 MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRLPROCEDURE IMAGING-Profees ACTIVE 0972 73222 $466.45CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210218 HC PR 73221 MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATPROCEDURE IMAGING-Profees ACTIVE 0972 73221 $388.37CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210219 HC PR 73218 MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MPROCEDURE IMAGING-Profees ACTIVE 0972 73218 $388.37CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210220 HC PR 72197 MRI PELVIS W/O & W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72197 $650.00CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210221 HC PR 72196 MRI PELVIS W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72196 $498.07CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210222 HC PR 72195 MRI PELVIS W/O CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72195 $419.99CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210223 HC PR 72157 MRI SPINAL CANAL THORACIC W/O & W/CONTR MA PROCEDURE IMAGING-Profees ACTIVE 0972 72157 $736.49CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210224 HC PR 72147 MRI SPINAL CANAL THORACIC W/CONTRAST MATRL PROCEDURE IMAGING-Profees ACTIVE 0972 72147 $552.94CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210225 HC PR 70130 RADEX MASTOIDS COMPL MINIMUM 3 VIEWS PR SIDPROCEDURE IMAGING-Profees ACTIVE 0972 70130 $83.03CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210226 HC PR 70160 RADEX NASAL BONES COMPLETE MINIMUM 3 VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 70160 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210227 HC PR 76010 RADEX FROM NOSE RECTUM FOREIGN BODY 1 VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 76010 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210228 HC PR 71111 RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWPROCEDURE IMAGING-Profees ACTIVE 0972 71111 $90.88CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210229 HC PR 70220 RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEPROCEDURE IMAGING-Profees ACTIVE 0972 70220 $71.86CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210230 HC PR 70210 RADEX SINUSES PARANASAL <3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 70210 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210245 HC PR 75635 CT ANGIO ABDOMINAL ARTERIES PROCEDURE IMAGING-Profees ACTIVE 0972 75635 $694.26CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210248 HC PR 71250 CT THORAX W/O CONTRAST MATERIAL PROCEDURE 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CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210250 HC PR 74177 CT ABDOMEN & PELVIS W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 74177 $444.52CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210251 HC PR 72125 CT CERVICAL SPINE W/O CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72125 $333.54CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210252 HC PR 72128 CT THORACIC SPINE W/O CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72128 $333.54CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210253 HC PR 72131 CT LUMBAR SPINE W/O CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72131 $333.54CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210254 HC PR 70491 CT SOFT TISSUE NECK W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 70491 $396.78CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210255 HC PR 70100 RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWPROCEDURE IMAGING-Profees ACTIVE 0972 70100 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210256 HC PR 70110 RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VI PROCEDURE IMAGING-Profees ACTIVE 0972 70110 $71.86CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210257 HC PR 70140 RADEX FACIAL BONES < 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 70140 $55.03CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210258 HC PR 70150 RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 70150 $73.95CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210259 HC PR 70330 RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH PROCEDURE IMAGING-Profees ACTIVE 0972 70330 $69.77CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210260 HC PR 70360 RADIOLOGIC EXAMINATION NECK SOFT TISSUE PROCEDURE IMAGING-Profees ACTIVE 0972 70360 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210263 HC PR 71120 X-RAY EXAM BREASTBONE 2/> VWS PROCEDURE IMAGING-Profees ACTIVE 0972 71120 $59.26CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210278 HC PR 77075 RADIOLOGIC EXAMINATION OSSEOUS SURVEY COM PROCEDURE IMAGING-Profees ACTIVE 0972 77075 $151.88CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210281 HC PR 71047 RADIOLOGIC EXAM CHEST 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 71047 $78.18CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210282 HC PR 71048 RADIOLOGIC EXAM CHEST 4+ VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 71048 $78.18CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210283 HC PR 70492 CT SOFT TISSUE NECK W/O & W/CONTRAST MATERI PROCEDURE IMAGING-Profees ACTIVE 0972 70492 $415.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210284 HC PR 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAPROCEDURE IMAGING-Profees ACTIVE 0972 70498 $504.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210285 HC PR 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRPROCEDURE IMAGING-Profees ACTIVE 0972 71275 $552.94CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210286 HC PR 73706 CT ANGIOGRAPHY LOWER EXTREMITY PROCEDURE IMAGING-Profees ACTIVE 0972 73706 $548.66CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210288 HC PR 74174 CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST PROCEDURE IMAGING-Profees ACTIVE 0972 74174 $544.07CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210289 HC PR 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAPROCEDURE IMAGING-Profees ACTIVE 0972 70496 $504.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210290 HC PR 71270 CT THORAX W/O & W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 71270 $396.78CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210291 HC PR 72126 CT CERVICAL SPINE W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72126 $350.37CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210292 HC PR 72127 CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72127 $373.58CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210293 HC PR 72130 CT THORACIC SPINE W/O & W/CONTRAST MATERIA PROCEDURE IMAGING-Profees ACTIVE 0972 72130 $375.77CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210294 HC PR 72132 CT LUMBAR SPINE W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72132 $350.37CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210295 HC PR 72133 CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72133 $375.77CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210296 HC PR 72191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRPROCEDURE IMAGING-Profees ACTIVE 0972 72191 $521.27CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210297 HC PR 72194 CT PELVIS W/O & W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 72194 $402.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210298 HC PR 73201 CT UPPER EXTREMITY W/CONTRAST MATERIAL PROCEDURE IMAGING-Profees ACTIVE 0972 73201 $333.54CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210299 HC PR 73206 CT ANGIOGRAPHY UPPER EXTREMITY PROCEDURE IMAGING-Profees ACTIVE 0972 73206 $521.27CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210302 HC PR 76604 US EXAM CHEST PROCEDURE IMAGING-Profees ACTIVE 0972 76604 $160.50CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210306 HC PR 76536 HEAD AND NECK SOFT TISSUES PROCEDURE IMAGING-Profees ACTIVE 0972 76536 $158.30CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210308 HC PR 76705 ECHO EXAM OF ABDOMEN PROCEDURE IMAGING-Profees ACTIVE 0972 76705 $171.05CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210309 HC PR 76810 US OB >= 14 WKS ADDL FETUS PROCEDURE IMAGING-Profees ACTIVE 0972 76810 $125.15CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210311 HC PR 93926 LOWER EXTREMITY STUDY DUPLEX PROCEDURE IMAGING-Profees ACTIVE 0972 93926 $118.32CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210315 HC PR 77077 JOINT SURVEY, SINGLE VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 77077 $52.22CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210316 HC PR 70030 X-RAY EYE FOR FOREIGN BODY PROCEDURE IMAGING-Profees ACTIVE 0972 70030 $90.88CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210317 HC PR 70200 X-RAY EXAM OF EYE SOCKETS PROCEDURE IMAGING-Profees ACTIVE 0972 70200 $80.33CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210318 HC PR 71045 X-RAY EXAM CHEST 1 VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 71045 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210319 HC PR 71046 X-RAY EXAM CHEST 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 71046 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210320 HC PR 74018 X-RAY EXAM ABDOMEN 1 VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 74018 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210321 HC PR 74019 X-RAY EXAM ABDOMEN 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 74019 $67.63CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210323 HC PR 73010 XR SCAPULA PROCEDURE IMAGING-Profees ACTIVE 0972 73010 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210324 HC PR 73020 XR SHOULER 1 VIEW PROCEDURE IMAGING-Profees ACTIVE 0972 73020 $44.42CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210325 HC PR 73030 XR SHOULER 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73030 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210326 HC PR 73050 XR SHOULDER ACROMIO-CLAVICULAR JOINTS PROCEDURE IMAGING-Profees ACTIVE 0972 73050 $59.26CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210329 HC PR 72040 XR SPINE 2-3 VIEWS CERVICAL PROCEDURE IMAGING-Profees ACTIVE 0972 72040 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210330 HC PR 72050 XR SPINE 4+ VIEWS CERVICAL PROCEDURE IMAGING-Profees ACTIVE 0972 72050 $88.79CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210331 HC PR 72070 XR SPINE 2 VIEWS THORACIC PROCEDURE IMAGING-Profees ACTIVE 0972 72070 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210332 HC PR 72072 XR SPINE 3 VIEWS THORACIC PROCEDURE IMAGING-Profees ACTIVE 0972 72072 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210333 HC PR 72100 XR SPINE 2-3 VIEWS LUMBAR PROCEDURE IMAGING-Profees ACTIVE 0972 72100 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210334 HC PR 72110 XR SPINE 4+ VIEWS LUMBAR PROCEDURE IMAGING-Profees ACTIVE 0972 72110 $88.79CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210336 HC PR 73000 XR COLLAR BONE PROCEDURE IMAGING-Profees ACTIVE 0972 73000 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210337 HC PR 73060 XR HUMERUS 2+ VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73060 $50.80

CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210338 HC PR 73070 XR ELBOW PROCEDURE IMAGING-Profees ACTIVE 0972 73070 $44.42CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210339 HC PR 73080 XR ELBOW 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73080 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210340 HC PR 73090 XR FOREARM PROCEDURE IMAGING-Profees ACTIVE 0972 73090 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210341 HC PR 73092 XR ARM INFANT PROCEDURE IMAGING-Profees ACTIVE 0972 73092 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210342 HC PR 73100 XR WRIST 1-2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73100 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210343 HC PR 73110 XR WRIST 3+ VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73110 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210344 HC PR 73120 XR HAND 1-2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73120 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210345 HC PR 73130 XR HAND 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73130 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210346 HC PR 73140 XR FINGER(S) 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73140 $38.20CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210347 HC PR 73560 XR KNEE 1-2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73560 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210348 HC PR 73562 XR KNEE 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73562 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210349 HC PR 73564 XR KNEE 4+ VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73564 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210350 HC PR 73565 XR KNEES STANDING PROCEDURE IMAGING-Profees ACTIVE 0972 73565 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210351 HC PR 73592 XR LEG INFANT PROCEDURE IMAGING-Profees ACTIVE 0972 73592 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210352 HC PR 73600 XR ANKLE 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73600 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210353 HC PR 73610 XR ANKLE 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73610 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210354 HC PR 73620 XR FOOT 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73620 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210355 HC PR 73630 XR FOOT 3 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73630 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210356 HC PR 73650 XR HEEL 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73650 $46.51CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210357 HC PR 73660 XR TOES(S) 2 VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 73660 $38.20CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210358 HC PR 71100 XR RIBS UNLTRL XRAY MDC PROCEDURE IMAGING-Profees ACTIVE 0972 71100 $63.39CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210359 HC PR 72202 XR SACROILIAC JOINTS 3+ VIEWS PROCEDURE IMAGING-Profees ACTIVE 0972 72202 $55.03CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210360 HC PR 71101 X-RAY RIBS, CHEST 3+ VW PROCEDURE IMAGING-Profees ACTIVE 0972 71101 $78.18CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210562 HC PR 70120 X-RAY MASTOIDS <3 VW PROCEDURE IMAGING-Profees ACTIVE 0972 70120 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210563 HC PR 70134 X-RAY MIDDLE EAR PROCEDURE IMAGING-Profees ACTIVE 0972 70134 $68.90CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210564 HC PR 70190 X-RAY OPTIC FORAMEN PROCEDURE IMAGING-Profees ACTIVE 0972 70190 $70.58CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210565 HC PR 70260 X-RAY SKULL 4+ VW PROCEDURE IMAGING-Profees ACTIVE 0972 70260 $86.14CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210566 HC PR 70328 X-RAY TMJ UNILAT PROCEDURE IMAGING-Profees ACTIVE 0972 70328 $52.89CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210567 HC PR 70545 MR ANGIO, HEAD W/CONTRAST PROCEDURE IMAGING-Profees ACTIVE 0972 70545 $344.05CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210568 HC PR 70546 MR ANGIO, HEAD, COMBO PROCEDURE IMAGING-Profees ACTIVE 0972 70546 $516.99CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210569 HC PR 71110 X-RAY RIBS 3 VW BILAT PROCEDURE IMAGING-Profees ACTIVE 0972 71110 $78.18CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210570 HC PR 71551 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IMAGING-Profees ACTIVE 0972 72159 $531.88CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210578 HC PR 72198 MR ANGIO PELVIS(MRA) PROCEDURE IMAGING-Profees ACTIVE 0972 72198 $516.99CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210579 HC PR 72200 X-RAY SACROILIAC JTS <3 VW PROCEDURE IMAGING-Profees ACTIVE 0972 72200 $50.80CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210580 HC PR 73219 MRI, UPPER EXTREM W/CONTRAST PROCEDURE IMAGING-Profees ACTIVE 0972 73219 $466.45CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210581 HC PR 73725 MR ANGIO LOWER EXTREM (MRA) PROCEDURE IMAGING-Profees ACTIVE 0972 73725 $523.46CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210582 HC PR 74185 MR ANGIO ABDOMEN (MRA) PROCEDURE IMAGING-Profees ACTIVE 0972 74185 $516.99CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210583 HC PR 76706 US ABDOMINAL AORTA REAL TIME SCREEN STUDY APROCEDURE IMAGING-Profees ACTIVE 0972 76706 $196.35CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210585 HC PR 78300 BONE IMAGING, LIMITED AREA PROCEDURE IMAGING-Profees ACTIVE 0972 78300 $204.26CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210586 HC PR 78585 LUNG V/Q IMAGING,REBREATH/WASHOUT PROCEDURE IMAGING-Profees ACTIVE 0972 78585 $314.52CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210587 HC PR 93306 ECHO TTE 2D W/COLOR & DOP PROCEDURE ECHO-Profees ACTIVE 0985 93306 $419.99CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210588 HC PR C8929 ECHO W/WO CONTRAST DOP COLOR PROCEDURE ECHO-Profees ACTIVE 0985 C8929 $545.60CC WCB DIAGNOSTIC IMAGING PHYSICIANS 97210589 HC PR 76942 SONO GUIDE NEEDLE BIOPSY [76942] PROCEDURE ECHO-Profees ACTIVE 0985 76942 $194.26CC WCB ELECTRODIAGNOSTICS 73010002 HC ECG 12 LEAD TRACING ONLY PROCEDURE EKG ACTIVE 0730 93005 $73.44CC WCB ELECTRODIAGNOSTICS 73010003 HC RHYTHM ECG TRACING ONLY PROCEDURE EKG ACTIVE 0730 93041 $26.52CC WCB ELECTRODIAGNOSTICS 73010219 HC INIT PREVNT EXAM SCREEN EKG, TRACING ONLY PROCEDURE EKG ACTIVE 0730 G0404 $73.44CC WCB ELECTRODIAGNOSTICS 73010220 HC INIT PREVNT EXAM SCREEN EKG W INTR & RPT PROCEDURE EKG ACTIVE 0730 G0403 $73.44CC WCB ELECTRODIAGNOSTICS 73110001 HC HOLTER MONITOR UP TO 48 HRS PROCEDURE EKG ACTIVE 0731 93225 $205.02

CC WCB ELECTRODIAGNOSTICS 73210001 HC CARDIAC EVENT MONITOR SET UP PROCEDURE EKG ACTIVE 0732 93270 $197.27CC WCB ELECTRODIAGNOSTICS 96910012 HC PRHOLTER MONITOR W/INTERP & REPT PROCEDURE EKG-Profees ACTIVE 0731 93224 $418.91CC WCB EMERGENCY PHYSICIANS 98110003 HC PR 99408 ALCOHOL/DRUG SCREEN 15-30 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99408 $192.83CC WCB EMERGENCY PHYSICIANS 98110003 HC PR 99408 ALCOHOL/DRUG SCREEN 15-30 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99408 $135.25CC WCB EMERGENCY PHYSICIANS 98110005 HC PR 99409 ALCOHOL/DRUG SCREEN > 30 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99409 $385.61CC WCB EMERGENCY PHYSICIANS 98110009 HC PR 99283 EMERGENCY DEPT VISIT LEVEL III PROCEDURE ER MAIN-Profees ACTIVE 0981 99283 $300.49CC WCB EMERGENCY PHYSICIANS 98110009 HC PR 99283 EMERGENCY DEPT VISIT LEVEL III PROCEDURE ER MAIN-Profees ACTIVE 0981 99283 $368.32CC WCB EMERGENCY PHYSICIANS 98110012 HC PR 99284 EMERGENCY DEPT VISIT LEVEL IV PROCEDURE ER MAIN-Profees ACTIVE 0981 99284 $448.75CC WCB EMERGENCY PHYSICIANS 98110012 HC PR 99284 EMERGENCY DEPT VISIT LEVEL IV PROCEDURE ER MAIN-Profees ACTIVE 0981 99284 $549.32CC WCB EMERGENCY PHYSICIANS 98110016 HC PR 99285 EMERGENCY DEPT VISIT LEVEL 5 PROCEDURE ER MAIN-Profees ACTIVE 0981 99285 $668.87CC WCB EMERGENCY PHYSICIANS 98110016 HC PR 99285 EMERGENCY DEPT VISIT LEVEL 5 PROCEDURE ER MAIN-Profees ACTIVE 0981 99285 $818.81CC WCB EMERGENCY PHYSICIANS 98110020 HC PR 99288 DIRECT ADVANCED LIFE SUPPORT PROCEDURE ER MAIN-Profees ACTIVE 0981 99288 $532.03CC WCB EMERGENCY PHYSICIANS 98110021 HC PR 99291 CRITICAL CARE FIRST HOUR PROCEDURE ER MAIN-Profees ACTIVE 0981 99291 $782.65CC WCB EMERGENCY PHYSICIANS 98110021 HC PR 99291 CRITICAL CARE FIRST HOUR PROCEDURE ER MAIN-Profees ACTIVE 0981 99291 $819.83CC WCB EMERGENCY PHYSICIANS 98110023 HC PR 99292 CRITICAL CARE ADDL 30 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99292 $391.48CC WCB EMERGENCY PHYSICIANS 98110023 HC PR 99292 CRITICAL CARE ADDL 30 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99292 $422.38CC WCB EMERGENCY PHYSICIANS 98110025 HC PR 0131C SANE EXAM 15-45 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0131C $499.90CC WCB EMERGENCY PHYSICIANS 98110025 HC PR 0131C SANE EXAM 15-45 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0131C $553.49CC WCB EMERGENCY PHYSICIANS 98110026 HC PR 0132C SANE EXAM 49-119 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0132C $692.48CC WCB EMERGENCY PHYSICIANS 98110026 HC PR 0132C SANE EXAM 49-119 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0132C $894.74CC WCB EMERGENCY PHYSICIANS 98110037 HC PR 11043 DEB MUSC/FASCIA 20 SQ CM/< CDM PROCEDURE ER MAIN-Profees ACTIVE 0981 11043 $618.99CC WCB EMERGENCY PHYSICIANS 98110038 HC PR 27831 CLTX PROX TIBFIB JT DISLC REQ ANES CDM PROCEDURE ER MAIN-Profees ACTIVE 0981 27831 $1,215.69CC WCB EMERGENCY PHYSICIANS 98110039 HC PR 10030 IMAGE-GUIDED CATHETER FLUID COLLECTION DRAI PROCEDURE ER MAIN-Profees ACTIVE 0981 10030 $1,254.40CC WCB EMERGENCY PHYSICIANS 98110040 HC PR 10021 FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE PROCEDURE ER MAIN-Profees ACTIVE 0981 10021 $353.02CC WCB EMERGENCY PHYSICIANS 98110041 HC PR 11770 EXCISION PILONIDAL CYST/SINUS SIMPLE CDM PROCEDURE ER MAIN-Profees ACTIVE 0981 11770 $840.17CC WCB EMERGENCY PHYSICIANS 98110042 HC PR 59050 FETAL MONITOR W/REPORT CDM PROCEDURE ER MAIN-Profees ACTIVE 0981 59050 $260.20CC WCB EMERGENCY PHYSICIANS 98110043 HC PR 36011 SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH CDMPROCEDURE ER MAIN-Profees ACTIVE 0981 36011 $2,254.20CC WCB EMERGENCY PHYSICIANS 98110044 HC PR 26615 TREAT METACARPAL FRACTURE W/INTERNAL FIXATI PROCEDURE ER MAIN-Profees ACTIVE 0981 26615 $1,979.36CC WCB EMERGENCY PHYSICIANS 98110045 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN CDM PROCEDURE ER MAIN-Profees ACTIVE 0981 99406 $94.45CC WCB EMERGENCY PHYSICIANS 98110046 HC PR 99305 NURSING FACILITY CARE INIT LEVEL 2 CDM PROCEDURE ER MAIN-Profees ACTIVE 0981 99305 $242.96CC WCB EMERGENCY PHYSICIANS 98110047 HC PR 99309 SBSQ NURSING FACIL CARE/DAY NEW PROBLEM 25 M PROCEDURE ER MAIN-Profees ACTIVE 0981 99309 $201.55CC WCB EMERGENCY PHYSICIANS 98110092 HC PR 01951 ANESTH,BURN TX, <4% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 01951 $175.34CC WCB EMERGENCY PHYSICIANS 98110093 HC PR 11012 DEBRIDE ASSOC OPEN FX/DISLO SKIN/MUS/BONE PROCEDURE ER MAIN-Profees ACTIVE 0981 11012 $1,887.46CC WCB EMERGENCY PHYSICIANS 98110094 HC PR 11621 EXC SKIN MALIG 0.6-1CM REMAINDR BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 11621 $528.82CC WCB EMERGENCY PHYSICIANS 98110095 HC PR 26675 CLOSED RX C-MC DISLOC,ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26675 $1,707.79CC WCB EMERGENCY PHYSICIANS 98110096 HC PR 26735 OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MID PROCEDURE ER MAIN-Profees ACTIVE 0981 26735 $2,541.43CC WCB EMERGENCY PHYSICIANS 98110097 HC PR 27087 REMOVE PELV/HIP F.B.,DEEP PROCEDURE ER MAIN-Profees ACTIVE 0981 27087 $2,515.42CC WCB EMERGENCY PHYSICIANS 98110098 HC PR 29085 APPLY HAND/WRIST CAST PROCEDURE ER MAIN-Profees ACTIVE 0981 29085 $228.63CC WCB EMERGENCY PHYSICIANS 98110099 HC PR 29450 APPLY OF CLUBFOOT CAST PROCEDURE ER MAIN-Profees ACTIVE 0981 29450 $240.31CC WCB EMERGENCY PHYSICIANS 98110100 HC PR 67715 CANTHOTOMY(SEPARATE PROCEDURE) PROCEDURE ER MAIN-Profees ACTIVE 0981 67715 $496.49CC WCB EMERGENCY PHYSICIANS 98110101 HC PR 92953 TEMP TRANSCUTANEOUS EXT PACING PROCEDURE ER MAIN-Profees ACTIVE 0981 92953 $190.18CC WCB EMERGENCY PHYSICIANS 98110101 HC PR 92953 TEMP TRANSCUTANEOUS EXT PACING PROCEDURE ER MAIN-Profees ACTIVE 0981 92953 $220.56CC WCB EMERGENCY PHYSICIANS 98110102 HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL PROCEDURE ER MAIN-Profees ACTIVE 0981 92960 $569.93CC WCB EMERGENCY PHYSICIANS 98110102 HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL PROCEDURE ER MAIN-Profees ACTIVE 0981 92960 $574.30CC WCB EMERGENCY PHYSICIANS 98110103 HC PR 92971 CARDIOASSIST EXTERNAL PROCEDURE ER MAIN-Profees ACTIVE 0981 92971 $236.59CC WCB EMERGENCY PHYSICIANS 98110104 HC PR 25929 AMPUTATION FOLLOW-UP SURGERY PROCEDURE ER MAIN-Profees ACTIVE 0981 25929 $572.58CC WCB EMERGENCY PHYSICIANS 98110105 HC PR 26591 REPAIR MUSCLES OF HAND PROCEDURE ER MAIN-Profees ACTIVE 0981 26591 $110.06CC WCB EMERGENCY PHYSICIANS 98110106 HC PR 26607 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BOPROCEDURE ER MAIN-Profees ACTIVE 0981 26607 $94.76CC WCB EMERGENCY PHYSICIANS 98110106 HC PR 26607 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BOPROCEDURE ER MAIN-Profees ACTIVE 0981 26607 $2,430.37CC WCB EMERGENCY PHYSICIANS 98110107 HC PR 29049 APPLICATION OF FIGURE EIGHT PROCEDURE ER MAIN-Profees ACTIVE 0981 29049 $132.60CC WCB EMERGENCY PHYSICIANS 98110108 HC PR 35188 REPAIR BLOOD VESSEL LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 35188 $138.47CC WCB EMERGENCY PHYSICIANS 98110109 HC PR 99466 PED CRIT CARE TRANSPORT PROCEDURE ER MAIN-Profees ACTIVE 0981 99466 $1,139.03CC WCB EMERGENCY PHYSICIANS 98110144 HC PR 99151 MOD SED SAME PHYS/QHP <5YRS 1ST 15 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99151 $146.17CC WCB EMERGENCY PHYSICIANS 98110145 HC PR 99152 MOD SED SAME PHYS/QHP 5/>YRS 1ST 15 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99152 $146.17CC WCB EMERGENCY PHYSICIANS 98110146 HC PR 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99153 $66.30

CC WCB EMERGENCY PHYSICIANS 98110146 HC PR 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99153 $102.00CC WCB EMERGENCY PHYSICIANS 98110200 HC PR 46250 HEMORRHOIDECTOMY,EXTERNAL, 2+ COLUMNS/GRPROCEDURE ER MAIN-Profees ACTIVE 0981 46250 $1,515.36CC WCB EMERGENCY PHYSICIANS 98110201 HC PR 46608 ANOSCOPY,REMOVE FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 46608 $382.45CC WCB EMERGENCY PHYSICIANS 98110202 HC PR 99460 INITIAL NORMAL NEWBORN CARE, HOSPITAL OR BIR PROCEDURE ER MAIN-Profees ACTIVE 0981 99460 $426.46CC WCB EMERGENCY PHYSICIANS 98110223 HC PR 36430 BLOOD TRANSFUSION SERVICE PROCEDURE ER MAIN-Profees ACTIVE 0981 36430 $170.03CC WCB EMERGENCY PHYSICIANS 98110226 HC PR 36680 INSERT NEEDLE BONE CAVITY PROCEDURE ER MAIN-Profees ACTIVE 0981 36680 $682.38CC WCB EMERGENCY PHYSICIANS 98110229 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10060 $250.61CC WCB EMERGENCY PHYSICIANS 98110229 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10060 $285.07CC WCB EMERGENCY PHYSICIANS 98110231 HC PR 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MUL PROCEDURE ER MAIN-Profees ACTIVE 0981 10061 $556.41CC WCB EMERGENCY PHYSICIANS 98110231 HC PR 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MUL PROCEDURE ER MAIN-Profees ACTIVE 0981 10061 $631.52CC WCB EMERGENCY PHYSICIANS 98110232 HC PR 10080 DRAINAGE OF PILONIDAL CYST SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10080 $417.18CC WCB EMERGENCY PHYSICIANS 98110232 HC PR 10080 DRAINAGE OF PILONIDAL CYST SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10080 $484.83CC WCB EMERGENCY PHYSICIANS 98110234 HC PR 10120 REMOVE FOREIGN BODY SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10120 $278.21CC WCB EMERGENCY PHYSICIANS 98110234 HC PR 10120 REMOVE FOREIGN BODY SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10120 $386.51CC WCB EMERGENCY PHYSICIANS 98110235 HC PR 10121 REMOVE FOREIGN BODY COMPLICATED PROCEDURE ER MAIN-Profees ACTIVE 0981 10121 $635.72CC WCB EMERGENCY PHYSICIANS 98110235 HC PR 10121 REMOVE FOREIGN BODY COMPLICATED PROCEDURE ER MAIN-Profees ACTIVE 0981 10121 $707.47CC WCB EMERGENCY PHYSICIANS 98110236 HC PR 10140 DRAINAGE OF HEMATOMA/FLUID PROCEDURE ER MAIN-Profees ACTIVE 0981 10140 $595.94CC WCB EMERGENCY PHYSICIANS 98110236 HC PR 10140 DRAINAGE OF HEMATOMA/FLUID PROCEDURE ER MAIN-Profees ACTIVE 0981 10140 $427.60CC WCB EMERGENCY PHYSICIANS 98110238 HC PR 10160 PUNCTURE DRAINAGE OF LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 10160 $238.68CC WCB EMERGENCY PHYSICIANS 98110238 HC PR 10160 PUNCTURE DRAINAGE OF LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 10160 $265.30CC WCB EMERGENCY PHYSICIANS 98110242 HC PR 11042 DEB SUBQ TISSUE 20 SQ CM/< PROCEDURE ER MAIN-Profees ACTIVE 0981 11042 $397.80CC WCB EMERGENCY PHYSICIANS 98110242 HC PR 11042 DEB SUBQ TISSUE 20 SQ CM/< PROCEDURE ER MAIN-Profees ACTIVE 0981 11042 $407.84CC WCB EMERGENCY PHYSICIANS 98110244 HC PR 11044 DEB BONE 20 SQ CM/< PROCEDURE ER MAIN-Profees ACTIVE 0981 11044 $397.80CC WCB EMERGENCY PHYSICIANS 98110245 HC PR 11045 DEB SUBQ TISSUE ADD-ON PROCEDURE ER MAIN-Profees ACTIVE 0981 11045 $96.49CC WCB EMERGENCY PHYSICIANS 98110251 HC PR 11730 REMOVAL OF NAIL PLATE PROCEDURE ER MAIN-Profees ACTIVE 0981 11730 $160.19CC WCB EMERGENCY PHYSICIANS 98110251 HC PR 11730 REMOVAL OF NAIL PLATE PROCEDURE ER MAIN-Profees ACTIVE 0981 11730 $189.35CC WCB EMERGENCY PHYSICIANS 98110253 HC PR 11740 DRAIN BLOOD FROM UNDER NAIL PROCEDURE ER MAIN-Profees ACTIVE 0981 11740 $95.47CC WCB EMERGENCY PHYSICIANS 98110253 HC PR 11740 DRAIN BLOOD FROM UNDER NAIL PROCEDURE ER MAIN-Profees ACTIVE 0981 11740 $112.36CC WCB EMERGENCY PHYSICIANS 98110254 HC PR 11750 REMOVAL OF NAIL BED PROCEDURE ER MAIN-Profees ACTIVE 0981 11750 $428.04CC WCB EMERGENCY PHYSICIANS 98110254 HC PR 11750 REMOVAL OF NAIL BED PROCEDURE ER MAIN-Profees ACTIVE 0981 11750 $504.59CC WCB EMERGENCY PHYSICIANS 98110259 HC PR 12001 REPAIR SUPERFICIAL WOUND(S)< 2.5CM SLP NK AX E PROCEDURE ER MAIN-Profees ACTIVE 0981 12001 $365.21CC WCB EMERGENCY PHYSICIANS 98110259 HC PR 12001 REPAIR SUPERFICIAL WOUND(S)< 2.5CM SLP NK AX E PROCEDURE ER MAIN-Profees ACTIVE 0981 12001 $445.29CC WCB EMERGENCY PHYSICIANS 98110260 HC PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP N PROCEDURE ER MAIN-Profees ACTIVE 0981 12002 $441.30CC WCB EMERGENCY PHYSICIANS 98110260 HC PR 12002 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP N PROCEDURE ER MAIN-Profees ACTIVE 0981 12002 $537.89CC WCB EMERGENCY PHYSICIANS 98110261 HC PR 12004 REPAIR SUPERFICIAL WOUND(S)7.6 TO 12.5CM SLP N PROCEDURE ER MAIN-Profees ACTIVE 0981 12004 $547.64CC WCB EMERGENCY PHYSICIANS 98110261 HC PR 12004 REPAIR SUPERFICIAL WOUND(S)7.6 TO 12.5CM SLP N PROCEDURE ER MAIN-Profees ACTIVE 0981 12004 $667.94CC WCB EMERGENCY PHYSICIANS 98110262 HC PR 12005 REPAIR SUPERFICIAL WOUND(S)12.6 TO 20.0CM SLP PROCEDURE ER MAIN-Profees ACTIVE 0981 12005 $578.14CC WCB EMERGENCY PHYSICIANS 98110262 HC PR 12005 REPAIR SUPERFICIAL WOUND(S)12.6 TO 20.0CM SLP PROCEDURE ER MAIN-Profees ACTIVE 0981 12005 $885.38CC WCB EMERGENCY PHYSICIANS 98110263 HC PR 12006 REPAIR SUPERFICIAL WOUND(S) 20.1-30.0CM SLP NK PROCEDURE ER MAIN-Profees ACTIVE 0981 12006 $699.62CC WCB EMERGENCY PHYSICIANS 98110264 HC PR 12007 REPAIR SUPERFICIAL WOUND(S) >30CM SLP NK AX E PROCEDURE ER MAIN-Profees ACTIVE 0981 12007 $754.80CC WCB EMERGENCY PHYSICIANS 98110265 HC PR 12011 REPAIR SUPERFICIAL WOUND(S) <2.5 FACE ERS EYLD PROCEDURE ER MAIN-Profees ACTIVE 0981 12011 $441.30CC WCB EMERGENCY PHYSICIANS 98110265 HC PR 12011 REPAIR SUPERFICIAL WOUND(S) <2.5 FACE ERS EYLD PROCEDURE ER MAIN-Profees ACTIVE 0981 12011 $537.89CC WCB EMERGENCY PHYSICIANS 98110266 HC PR 12013 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 5.0CM FACE PROCEDURE ER MAIN-Profees ACTIVE 0981 12013 $517.14CC WCB EMERGENCY PHYSICIANS 98110266 HC PR 12013 REPAIR SUPERFICIAL WOUND(S) 2.6 TO 5.0CM FACE PROCEDURE ER MAIN-Profees ACTIVE 0981 12013 $630.48CC WCB EMERGENCY PHYSICIANS 98110267 HC PR 12014 REPAIR SUPERFICIAL WOUND(S) 5.1 TO 7.5CM FACE PROCEDURE ER MAIN-Profees ACTIVE 0981 12014 $593.28CC WCB EMERGENCY PHYSICIANS 98110267 HC PR 12014 REPAIR SUPERFICIAL WOUND(S) 5.1 TO 7.5CM FACE PROCEDURE ER MAIN-Profees ACTIVE 0981 12014 $751.17CC WCB EMERGENCY PHYSICIANS 98110268 HC PR 12015 REPAIR SUPERFICIAL WOUND(S) 7.6 TO 12.5CM FACE PROCEDURE ER MAIN-Profees ACTIVE 0981 12015 $776.02CC WCB EMERGENCY PHYSICIANS 98110268 HC PR 12015 REPAIR SUPERFICIAL WOUND(S) 7.6 TO 12.5CM FACE PROCEDURE ER MAIN-Profees ACTIVE 0981 12015 $945.72CC WCB EMERGENCY PHYSICIANS 98110269 HC PR 12016 REPAIR SUPERFICIAL WOUND(S) 12.6 TO 20.0CM FAC PROCEDURE ER MAIN-Profees ACTIVE 0981 12016 $958.19CC WCB EMERGENCY PHYSICIANS 98110270 HC PR 12017 REPAIR SUPERFICIAL WOUND(S) 20.1 TO 30.0CM FAC PROCEDURE ER MAIN-Profees ACTIVE 0981 12017 $1,916.38CC WCB EMERGENCY PHYSICIANS 98110274 HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12031 $420.09CC WCB EMERGENCY PHYSICIANS 98110274 HC PR 12031 INTMD WND REPAIR S/TR/EXT UP TO 2.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12031 $487.95CC WCB EMERGENCY PHYSICIANS 98110275 HC PR 12032 INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12032 $541.82CC WCB EMERGENCY PHYSICIANS 98110275 HC PR 12032 INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12032 $629.44CC WCB EMERGENCY PHYSICIANS 98110276 HC PR 12034 INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12034 $609.71

CC WCB EMERGENCY PHYSICIANS 98110276 HC PR 12034 INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12034 $707.47CC WCB EMERGENCY PHYSICIANS 98110277 HC PR 12035 INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12035 $826.10CC WCB EMERGENCY PHYSICIANS 98110277 HC PR 12035 INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12035 $959.25CC WCB EMERGENCY PHYSICIANS 98110278 HC PR 12036 INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12036 $1,069.83CC WCB EMERGENCY PHYSICIANS 98110278 HC PR 12036 INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12036 $1,457.60CC WCB EMERGENCY PHYSICIANS 98110279 HC PR 12037 INTMD WND REPAIR S/TR/EXT > 30 CM. PROCEDURE ER MAIN-Profees ACTIVE 0981 12037 $1,309.32CC WCB EMERGENCY PHYSICIANS 98110280 HC PR 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12041 $501.53CC WCB EMERGENCY PHYSICIANS 98110280 HC PR 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12041 $582.62CC WCB EMERGENCY PHYSICIANS 98110281 HC PR 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12042 $541.82CC WCB EMERGENCY PHYSICIANS 98110281 HC PR 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12042 $629.44CC WCB EMERGENCY PHYSICIANS 98110282 HC PR 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12044 $704.41CC WCB EMERGENCY PHYSICIANS 98110282 HC PR 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12044 $817.75CC WCB EMERGENCY PHYSICIANS 98110284 HC PR 12045 INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12045 $1,191.56CC WCB EMERGENCY PHYSICIANS 98110287 HC PR 12051 INTMD WND REPAIR FACE/MM <2.5 CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12051 $609.71CC WCB EMERGENCY PHYSICIANS 98110287 HC PR 12051 INTMD WND REPAIR FACE/MM <2.5 CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12051 $707.47CC WCB EMERGENCY PHYSICIANS 98110288 HC PR 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12052 $677.33CC WCB EMERGENCY PHYSICIANS 98110288 HC PR 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12052 $786.54CC WCB EMERGENCY PHYSICIANS 98110289 HC PR 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12053 $894.03CC WCB EMERGENCY PHYSICIANS 98110289 HC PR 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12053 $1,038.32CC WCB EMERGENCY PHYSICIANS 98110290 HC PR 12054 INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12054 $1,164.79CC WCB EMERGENCY PHYSICIANS 98110291 HC PR 12055 INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12055 $1,489.66CC WCB EMERGENCY PHYSICIANS 98110294 HC PR 13100 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13100 $447.17CC WCB EMERGENCY PHYSICIANS 98110295 HC PR 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13101 $799.88CC WCB EMERGENCY PHYSICIANS 98110295 HC PR 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13101 $854.17CC WCB EMERGENCY PHYSICIANS 98110297 HC PR 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13120 $705.99CC WCB EMERGENCY PHYSICIANS 98110297 HC PR 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13120 $753.25CC WCB EMERGENCY PHYSICIANS 98110298 HC PR 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13121 $1,082.32CC WCB EMERGENCY PHYSICIANS 98110298 HC PR 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13121 $1,155.88CC WCB EMERGENCY PHYSICIANS 98110299 HC PR 13122 REPAIR WOUND/LESION ADD-ON 5CM OR LESS COM PROCEDURE ER MAIN-Profees ACTIVE 0981 13122 $435.49CC WCB EMERGENCY PHYSICIANS 98110299 HC PR 13122 REPAIR WOUND/LESION ADD-ON 5CM OR LESS COM PROCEDURE ER MAIN-Profees ACTIVE 0981 13122 $585.75CC WCB EMERGENCY PHYSICIANS 98110304 HC PR 1040M ACCIDENT REPORT PROCEDURE ER MAIN-Profees ACTIVE 0981 1040M $112.71CC WCB EMERGENCY PHYSICIANS 98110304 HC PR 1040M ACCIDENT REPORT PROCEDURE ER MAIN-Profees ACTIVE 0981 1040M $108.20CC WCB EMERGENCY PHYSICIANS 98110316 HC PR 30300 REMOVE NASAL FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 30300 $247.45CC WCB EMERGENCY PHYSICIANS 98110316 HC PR 30300 REMOVE NASAL FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 30300 $256.98CC WCB EMERGENCY PHYSICIANS 98110317 HC PR 30901 CONTROL OF NOSEBLEED SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 30901 $286.72CC WCB EMERGENCY PHYSICIANS 98110317 HC PR 30901 CONTROL OF NOSEBLEED SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 30901 $328.77CC WCB EMERGENCY PHYSICIANS 98110319 HC PR 30903 CONTROL OF NOSEBLEED COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 30903 $424.07CC WCB EMERGENCY PHYSICIANS 98110319 HC PR 30903 CONTROL OF NOSEBLEED COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 30903 $485.87CC WCB EMERGENCY PHYSICIANS 98110321 HC PR 30905 CONTROL OF NOSEBLEED POSTERIOR PROCEDURE ER MAIN-Profees ACTIVE 0981 30905 $767.75CC WCB EMERGENCY PHYSICIANS 98110321 HC PR 30905 CONTROL OF NOSEBLEED POSTERIOR PROCEDURE ER MAIN-Profees ACTIVE 0981 30905 $879.14CC WCB EMERGENCY PHYSICIANS 98110324 HC PR 31500 INS EMERGENCY AIRWAY PROCEDURE ER MAIN-Profees ACTIVE 0981 31500 $537.03CC WCB EMERGENCY PHYSICIANS 98110324 HC PR 31500 INS EMERGENCY AIRWAY PROCEDURE ER MAIN-Profees ACTIVE 0981 31500 $633.60CC WCB EMERGENCY PHYSICIANS 98110335 HC PR 31603 TRACHEOSTOMY PROCEDURE ER MAIN-Profees ACTIVE 0981 31603 $1,656.17CC WCB EMERGENCY PHYSICIANS 98110342 HC PR 32551 INSERTION OF CHEST TUBE PROCEDURE ER MAIN-Profees ACTIVE 0981 32551 $796.16CC WCB EMERGENCY PHYSICIANS 98110342 HC PR 32551 INSERTION OF CHEST TUBE PROCEDURE ER MAIN-Profees ACTIVE 0981 32551 $858.33CC WCB EMERGENCY PHYSICIANS 98110360 HC PR 41800 DRAINAGE OF GUM LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 41800 $445.28CC WCB EMERGENCY PHYSICIANS 98110361 HC PR 42000 DRAINAGE MOUTH ROOF LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 42000 $750.01CC WCB EMERGENCY PHYSICIANS 98110366 HC PR 42700 DRAINAGE OF TONSIL ABSCESS PROCEDURE ER MAIN-Profees ACTIVE 0981 42700 $528.56CC WCB EMERGENCY PHYSICIANS 98110368 HC PR 42809 REMOVE PHARYNX FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 42809 $451.66CC WCB EMERGENCY PHYSICIANS 98110375 HC PR 43753 TX GASTRO INTUB W/ASP PROCEDURE ER MAIN-Profees ACTIVE 0981 43753 $403.41CC WCB EMERGENCY PHYSICIANS 98110375 HC PR 43753 TX GASTRO INTUB W/ASP PROCEDURE ER MAIN-Profees ACTIVE 0981 43753 $402.63CC WCB EMERGENCY PHYSICIANS 98110380 HC PR 45915 REMOVE RECTAL OBSTRUCTION PROCEDURE ER MAIN-Profees ACTIVE 0981 45915 $760.61CC WCB EMERGENCY PHYSICIANS 98110383 HC PR 46083 INCISE EXTERNAL HEMORRHOID PROCEDURE ER MAIN-Profees ACTIVE 0981 46083 $402.59CC WCB EMERGENCY PHYSICIANS 98110383 HC PR 46083 INCISE EXTERNAL HEMORRHOID PROCEDURE ER MAIN-Profees ACTIVE 0981 46083 $410.96CC WCB EMERGENCY PHYSICIANS 98110387 HC PR 46600 DIAGNOSTIC ANOSCOPY PROCEDURE ER MAIN-Profees ACTIVE 0981 46600 $281.11

CC WCB EMERGENCY PHYSICIANS 98110387 HC PR 46600 DIAGNOSTIC ANOSCOPY PROCEDURE ER MAIN-Profees ACTIVE 0981 46600 $225.77CC WCB EMERGENCY PHYSICIANS 98110396 HC PR 51702 INSERT TEMP BLADDER CATHETER PROCEDURE ER MAIN-Profees ACTIVE 0981 51702 $239.24CC WCB EMERGENCY PHYSICIANS 98110396 HC PR 51702 INSERT TEMP BLADDER CATHETER PROCEDURE ER MAIN-Profees ACTIVE 0981 51702 $262.18CC WCB EMERGENCY PHYSICIANS 98110397 HC PR 51703 INSERT BLADDER CATHETER COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 51703 $440.23CC WCB EMERGENCY PHYSICIANS 98110397 HC PR 51703 INSERT BLADDER CATHETER COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 51703 $481.71CC WCB EMERGENCY PHYSICIANS 98110402 HC PR 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MA PROCEDURE ER MAIN-Profees ACTIVE 0981 27786 $941.46CC WCB EMERGENCY PHYSICIANS 98110402 HC PR 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MA PROCEDURE ER MAIN-Profees ACTIVE 0981 27786 $1,090.34CC WCB EMERGENCY PHYSICIANS 98110405 HC PR 27788 CLOSED TREATMENT OF ANKLE FRACTURE W/MANI PROCEDURE ER MAIN-Profees ACTIVE 0981 27788 $1,788.26CC WCB EMERGENCY PHYSICIANS 98110406 HC PR 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MAN PROCEDURE ER MAIN-Profees ACTIVE 0981 27808 $1,088.65CC WCB EMERGENCY PHYSICIANS 98110406 HC PR 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MAN PROCEDURE ER MAIN-Profees ACTIVE 0981 27808 $1,503.38CC WCB EMERGENCY PHYSICIANS 98110409 HC PR 27810 TREATMENT OF ANKLE FRACTURE W/MANIPULATIO PROCEDURE ER MAIN-Profees ACTIVE 0981 27810 $2,059.28CC WCB EMERGENCY PHYSICIANS 98110410 HC PR 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATIONPROCEDURE ER MAIN-Profees ACTIVE 0981 27816 $1,206.15CC WCB EMERGENCY PHYSICIANS 98110410 HC PR 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATIONPROCEDURE ER MAIN-Profees ACTIVE 0981 27816 $1,397.26CC WCB EMERGENCY PHYSICIANS 98110413 HC PR 27818 CLOSED TX OF ANKLE FRACTURE TRIMALL W/MANIPPROCEDURE ER MAIN-Profees ACTIVE 0981 27818 $2,353.40CC WCB EMERGENCY PHYSICIANS 98110414 HC PR 27824 CLOSED TREAT LOWER LEG FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27824 $1,139.34CC WCB EMERGENCY PHYSICIANS 98110414 HC PR 27824 CLOSED TREAT LOWER LEG FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27824 $1,397.26CC WCB EMERGENCY PHYSICIANS 98110417 HC PR 27840 CLOSED TREATMENT OF ANKLE DISLOCATION W/O APROCEDURE ER MAIN-Profees ACTIVE 0981 27840 $794.58CC WCB EMERGENCY PHYSICIANS 98110418 HC PR 27842 CLOSED TREAT ANKLE DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 27842 $1,338.75CC WCB EMERGENCY PHYSICIANS 98110419 HC PR 28192 REMOVAL OF FOOT FOREIGN BODY DEEP PROCEDURE ER MAIN-Profees ACTIVE 0981 28192 $1,560.19CC WCB EMERGENCY PHYSICIANS 98110424 HC PR 28400 TREATMENT OF HEEL FRACTURE W/O MANIPULATIOPROCEDURE ER MAIN-Profees ACTIVE 0981 28400 $1,231.09CC WCB EMERGENCY PHYSICIANS 98110426 HC PR 28405 TREATMENT OF HEEL FRACTURE W/MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 28405 $1,580.34CC WCB EMERGENCY PHYSICIANS 98110429 HC PR 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28430 $914.43CC WCB EMERGENCY PHYSICIANS 98110429 HC PR 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28430 $1,119.47CC WCB EMERGENCY PHYSICIANS 98110432 HC PR 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28450 $792.69CC WCB EMERGENCY PHYSICIANS 98110432 HC PR 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28450 $1,042.48CC WCB EMERGENCY PHYSICIANS 98110436 HC PR 28470 TREAT METATARSAL FRACTURE W/O MANIPULATIO PROCEDURE ER MAIN-Profees ACTIVE 0981 28470 $729.61CC WCB EMERGENCY PHYSICIANS 98110436 HC PR 28470 TREAT METATARSAL FRACTURE W/O MANIPULATIO PROCEDURE ER MAIN-Profees ACTIVE 0981 28470 $827.12CC WCB EMERGENCY PHYSICIANS 98110438 HC PR 28475 CLOSED TREAT METATARSAL FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28475 $1,003.02CC WCB EMERGENCY PHYSICIANS 98110440 HC PR 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28490 $410.55CC WCB EMERGENCY PHYSICIANS 98110440 HC PR 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28490 $542.05CC WCB EMERGENCY PHYSICIANS 98110443 HC PR 28495 TREAT BIG TOE FRACTURE W/MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 28495 $487.56CC WCB EMERGENCY PHYSICIANS 98110445 HC PR 28510 TREATMENT OF TOE FRACTURE PHALANX PROCEDURE ER MAIN-Profees ACTIVE 0981 28510 $334.46CC WCB EMERGENCY PHYSICIANS 98110445 HC PR 28510 TREATMENT OF TOE FRACTURE PHALANX PROCEDURE ER MAIN-Profees ACTIVE 0981 28510 $423.44CC WCB EMERGENCY PHYSICIANS 98110448 HC PR 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28515 $501.79CC WCB EMERGENCY PHYSICIANS 98110448 HC PR 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28515 $568.06CC WCB EMERGENCY PHYSICIANS 98110449 HC PR 28525 OPEN TREAT TOE FRACTURE PHALANX PROCEDURE ER MAIN-Profees ACTIVE 0981 28525 $1,675.30CC WCB EMERGENCY PHYSICIANS 98110450 HC PR 28530 TREAT SESAMOID BONE FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 28530 $608.12CC WCB EMERGENCY PHYSICIANS 98110456 HC PR 28575 TREAT FOOT DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 28575 $1,094.26CC WCB EMERGENCY PHYSICIANS 98110464 HC PR 28665 TREAT TOE DISLOCATION W/ANETH PROCEDURE ER MAIN-Profees ACTIVE 0981 28665 $532.03CC WCB EMERGENCY PHYSICIANS 98110466 HC PR 29065 LONG ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29065 $314.57CC WCB EMERGENCY PHYSICIANS 98110466 HC PR 29065 LONG ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29065 $352.70CC WCB EMERGENCY PHYSICIANS 98110467 HC PR 29075 SHORT ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29075 $243.22CC WCB EMERGENCY PHYSICIANS 98110467 HC PR 29075 SHORT ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29075 $272.58CC WCB EMERGENCY PHYSICIANS 98110468 HC PR 29105 LONG ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29105 $198.39CC WCB EMERGENCY PHYSICIANS 98110468 HC PR 29105 LONG ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29105 $224.73CC WCB EMERGENCY PHYSICIANS 98110469 HC PR 29125 SHORT ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29125 $171.62CC WCB EMERGENCY PHYSICIANS 98110469 HC PR 29125 SHORT ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29125 $264.26CC WCB EMERGENCY PHYSICIANS 98110473 HC PR 29260 STRAPPING OF ELBOW OR WRIST PROCEDURE ER MAIN-Profees ACTIVE 0981 29260 $100.27CC WCB EMERGENCY PHYSICIANS 98110473 HC PR 29260 STRAPPING OF ELBOW OR WRIST PROCEDURE ER MAIN-Profees ACTIVE 0981 29260 $112.36CC WCB EMERGENCY PHYSICIANS 98110476 HC PR 29405 SHORT LEG CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29405 $343.18CC WCB EMERGENCY PHYSICIANS 98110476 HC PR 29405 SHORT LEG CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29405 $384.95CC WCB EMERGENCY PHYSICIANS 98110479 HC PR 29505 APPLICATION LONG LEG SPLINT PROCEDURE ER MAIN-Profees ACTIVE 0981 29505 $286.16CC WCB EMERGENCY PHYSICIANS 98110479 HC PR 29505 APPLICATION LONG LEG SPLINT PROCEDURE ER MAIN-Profees ACTIVE 0981 29505 $321.48CC WCB EMERGENCY PHYSICIANS 98110480 HC PR 29515 SHORT LEG SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29515 $185.95CC WCB EMERGENCY PHYSICIANS 98110480 HC PR 29515 SHORT LEG SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29515 $209.12

CC WCB EMERGENCY PHYSICIANS 98110482 HC PR 29580 APPLICATION OF UNABOOT PROCEDURE ER MAIN-Profees ACTIVE 0981 29580 $160.19CC WCB EMERGENCY PHYSICIANS 98110482 HC PR 29580 APPLICATION OF UNABOOT PROCEDURE ER MAIN-Profees ACTIVE 0981 29580 $179.99CC WCB EMERGENCY PHYSICIANS 98110486 HC PR 29345 APPLICATION/LONG LEG CAST PROCEDURE ER MAIN-Profees ACTIVE 0981 29345 $414.53CC WCB EMERGENCY PHYSICIANS 98110486 HC PR 29345 APPLICATION/LONG LEG CAST PROCEDURE ER MAIN-Profees ACTIVE 0981 29345 $465.06CC WCB EMERGENCY PHYSICIANS 98110489 HC PR 99282 EMERGENCY DEPT VISIT LEVEL II PROCEDURE ER MAIN-Profees ACTIVE 0981 99282 $199.72CC WCB EMERGENCY PHYSICIANS 98110489 HC PR 99282 EMERGENCY DEPT VISIT LEVEL II PROCEDURE ER MAIN-Profees ACTIVE 0981 99282 $244.49CC WCB EMERGENCY PHYSICIANS 98110494 HC PR 36556 INSERT NON-TUNNEL CV CATH > 5 PROCEDURE ER MAIN-Profees ACTIVE 0981 36556 $769.90CC WCB EMERGENCY PHYSICIANS 98110496 HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/> PROCEDURE ER MAIN-Profees ACTIVE 0981 36569 $942.28CC WCB EMERGENCY PHYSICIANS 98110501 HC PR 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13131 $823.45CC WCB EMERGENCY PHYSICIANS 98110501 HC PR 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13131 $879.14CC WCB EMERGENCY PHYSICIANS 98110502 HC PR 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13132 $1,599.46CC WCB EMERGENCY PHYSICIANS 98110502 HC PR 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13132 $1,708.34CC WCB EMERGENCY PHYSICIANS 98110503 HC PR 13133 REPAIR WOUND/LESION ADD-ON 5CM CMPLX, FRHD PROCEDURE ER MAIN-Profees ACTIVE 0981 13133 $635.15CC WCB EMERGENCY PHYSICIANS 98110503 HC PR 13133 REPAIR WOUND/LESION ADD-ON 5CM CMPLX, FRHD PROCEDURE ER MAIN-Profees ACTIVE 0981 13133 $780.30CC WCB EMERGENCY PHYSICIANS 98110505 HC PR 13151 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13151 $1,035.10CC WCB EMERGENCY PHYSICIANS 98110505 HC PR 13151 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13151 $1,104.90CC WCB EMERGENCY PHYSICIANS 98110506 HC PR 13152 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13152 $2,022.97CC WCB EMERGENCY PHYSICIANS 98110506 HC PR 13152 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13152 $2,159.87CC WCB EMERGENCY PHYSICIANS 98110507 HC PR 13153 REPAIR WOUND/LESION ADD-ON 5CM CMPLX EYLD PROCEDURE ER MAIN-Profees ACTIVE 0981 13153 $1,259.45CC WCB EMERGENCY PHYSICIANS 98110509 HC PR 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX PROCEDURE ER MAIN-Profees ACTIVE 0981 16000 $141.88CC WCB EMERGENCY PHYSICIANS 98110509 HC PR 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX PROCEDURE ER MAIN-Profees ACTIVE 0981 16000 $158.14CC WCB EMERGENCY PHYSICIANS 98110510 HC PR 16020 DRESS/DEBRID P-THICK BURN S <5% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16020 $219.10CC WCB EMERGENCY PHYSICIANS 98110510 HC PR 16020 DRESS/DEBRID P-THICK BURN S <5% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16020 $243.45CC WCB EMERGENCY PHYSICIANS 98110511 HC PR 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16025 $347.72CC WCB EMERGENCY PHYSICIANS 98110511 HC PR 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16025 $387.03CC WCB EMERGENCY PHYSICIANS 98110512 HC PR 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16030 $515.05CC WCB EMERGENCY PHYSICIANS 98110512 HC PR 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16030 $573.26CC WCB EMERGENCY PHYSICIANS 98110517 HC PR 20100 EXPLORE WOUND NECK PROCEDURE ER MAIN-Profees ACTIVE 0981 20100 $2,174.39CC WCB EMERGENCY PHYSICIANS 98110520 HC PR 20103 EXPLORE WOUND EXTREMITY PROCEDURE ER MAIN-Profees ACTIVE 0981 20103 $2,174.39CC WCB EMERGENCY PHYSICIANS 98110520 HC PR 20103 EXPLORE WOUND EXTREMITY PROCEDURE ER MAIN-Profees ACTIVE 0981 20103 $197.68CC WCB EMERGENCY PHYSICIANS 98110521 HC PR 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP PROCEDURE ER MAIN-Profees ACTIVE 0981 20520 $422.99CC WCB EMERGENCY PHYSICIANS 98110521 HC PR 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP PROCEDURE ER MAIN-Profees ACTIVE 0981 20520 $485.87CC WCB EMERGENCY PHYSICIANS 98110522 HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 20525 $1,063.20CC WCB EMERGENCY PHYSICIANS 98110522 HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 20525 $1,220.39CC WCB EMERGENCY PHYSICIANS 98110525 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL PROCEDURE ER MAIN-Profees ACTIVE 0981 20552 $195.74CC WCB EMERGENCY PHYSICIANS 98110525 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL PROCEDURE ER MAIN-Profees ACTIVE 0981 20552 $250.74CC WCB EMERGENCY PHYSICIANS 98110528 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOU PROCEDURE ER MAIN-Profees ACTIVE 0981 20600 $264.69CC WCB EMERGENCY PHYSICIANS 98110528 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOU PROCEDURE ER MAIN-Profees ACTIVE 0981 20600 $222.65CC WCB EMERGENCY PHYSICIANS 98110529 HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASO PROCEDURE ER MAIN-Profees ACTIVE 0981 20605 $205.53CC WCB EMERGENCY PHYSICIANS 98110529 HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASO PROCEDURE ER MAIN-Profees ACTIVE 0981 20605 $236.17CC WCB EMERGENCY PHYSICIANS 98110531 HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR PROCEDURE ER MAIN-Profees ACTIVE 0981 20610 $229.96CC WCB EMERGENCY PHYSICIANS 98110531 HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR PROCEDURE ER MAIN-Profees ACTIVE 0981 20610 $264.26CC WCB EMERGENCY PHYSICIANS 98110533 HC PR 21310 TREATMENT OF NOSE FRACTURE W/O MANIPULATI PROCEDURE ER MAIN-Profees ACTIVE 0981 21310 $452.17CC WCB EMERGENCY PHYSICIANS 98110533 HC PR 21310 TREATMENT OF NOSE FRACTURE W/O MANIPULATI PROCEDURE ER MAIN-Profees ACTIVE 0981 21310 $572.22CC WCB EMERGENCY PHYSICIANS 98110540 HC PR 21450 TREAT LOWER JAW FRACTURE W/O MANIPULATIONPROCEDURE ER MAIN-Profees ACTIVE 0981 21450 $1,490.99CC WCB EMERGENCY PHYSICIANS 98110541 HC PR 21480 RESET DISLOCATED JAW UNCOMPLICATED PROCEDURE ER MAIN-Profees ACTIVE 0981 21480 $452.17CC WCB EMERGENCY PHYSICIANS 98110551 HC PR 23500 TREAT CLAVICLE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23500 $659.02CC WCB EMERGENCY PHYSICIANS 98110551 HC PR 23500 TREAT CLAVICLE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23500 $767.82CC WCB EMERGENCY PHYSICIANS 98110558 HC PR 23540 TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MA PROCEDURE ER MAIN-Profees ACTIVE 0981 23540 $861.14CC WCB EMERGENCY PHYSICIANS 98110561 HC PR 23570 TREAT SHOULDER BLADE FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23570 $784.23CC WCB EMERGENCY PHYSICIANS 98110561 HC PR 23570 TREAT SHOULDER BLADE FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23570 $914.51CC WCB EMERGENCY PHYSICIANS 98110563 HC PR 23600 TREAT HUMERUS FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23600 $1,003.78CC WCB EMERGENCY PHYSICIANS 98110563 HC PR 23600 TREAT HUMERUS FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23600 $1,169.41CC WCB EMERGENCY PHYSICIANS 98110566 HC PR 23620 TREAT HUMERUS FRACTURE TUBEROSITY W/O MANPROCEDURE ER MAIN-Profees ACTIVE 0981 23620 $904.08CC WCB EMERGENCY PHYSICIANS 98110570 HC PR 23650 TREAT SHOULDER DISLOCATION W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23650 $878.37

CC WCB EMERGENCY PHYSICIANS 98110570 HC PR 23650 TREAT SHOULDER DISLOCATION W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23650 $1,023.75CC WCB EMERGENCY PHYSICIANS 98110572 HC PR 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNESPROCEDURE ER MAIN-Profees ACTIVE 0981 23655 $1,317.53CC WCB EMERGENCY PHYSICIANS 98110572 HC PR 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNESPROCEDURE ER MAIN-Profees ACTIVE 0981 23655 $1,535.63CC WCB EMERGENCY PHYSICIANS 98110577 HC PR 23930 DRAINAGE OF ARM LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 23930 $1,191.82CC WCB EMERGENCY PHYSICIANS 98110583 HC PR 21400 TREAT EYE SOCKET FRACTURE NON BLOWOUT W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 21400 $667.79CC WCB EMERGENCY PHYSICIANS 98110584 HC PR 24200 REMOVAL OF ARM FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 24200 $357.77CC WCB EMERGENCY PHYSICIANS 98110595 HC PR 99195 PHLEBOTOMY PROCEDURE ER MAIN-Profees ACTIVE 0981 99195 $87.82CC WCB EMERGENCY PHYSICIANS 98110596 HC PR 92950 CARDIOPULMONARY RESUSCITATION PROCEDURE ER MAIN-Profees ACTIVE 0981 92950 $683.96CC WCB EMERGENCY PHYSICIANS 98110596 HC PR 92950 CARDIOPULMONARY RESUSCITATION PROCEDURE ER MAIN-Profees ACTIVE 0981 92950 $792.78CC WCB EMERGENCY PHYSICIANS 98110602 HC PR 59409 VAGINAL DELIVERY PROCEDURE ER MAIN-Profees ACTIVE 0981 59409 $2,493.44CC WCB EMERGENCY PHYSICIANS 98110603 HC PR 59414 DELIVER PLACENTA PROCEDURE ER MAIN-Profees ACTIVE 0981 59414 $828.75CC WCB EMERGENCY PHYSICIANS 98110603 HC PR 59414 DELIVER PLACENTA PROCEDURE ER MAIN-Profees ACTIVE 0981 59414 $889.54CC WCB EMERGENCY PHYSICIANS 98110604 HC PR 99281 EMERGENCY DEPT VISIT LEVEL I PROCEDURE ER MAIN-Profees ACTIVE 0981 99281 $148.51CC WCB EMERGENCY PHYSICIANS 98110604 HC PR 99281 EMERGENCY DEPT VISIT LEVEL I PROCEDURE ER MAIN-Profees ACTIVE 0981 99281 $182.07CC WCB EMERGENCY PHYSICIANS 98110695 HC PR 99498 ADVANCE CARE PLANNING EA ADDL 30 MINS PROCEDURE ER MAIN-Profees ACTIVE 99498 $91.80CC WCB EMERGENCY PHYSICIANS 98110696 HC PR 99497 ADVANCE CARE PLANNING FIRST 30 MINS PROCEDURE ER MAIN-Profees ACTIVE 99497 $146.68CC WCB EMERGENCY PHYSICIANS 98110697 HC PR 29581 APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANK PROCEDURE ER MAIN-Profees ACTIVE 29581 $242.15CC WCB EMERGENCY PHYSICIANS 98110701 HC PR 24500 TREAT HUMERUS FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 24500 $1,030.05CC WCB EMERGENCY PHYSICIANS 98110701 HC PR 24500 TREAT HUMERUS FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 24500 $1,187.10CC WCB EMERGENCY PHYSICIANS 98110703 HC PR 24505 TREAT HUMERUS FX W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 24505 $2,353.40CC WCB EMERGENCY PHYSICIANS 98110704 HC PR 24530 TREAT HUMERUS FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24530 $1,206.41CC WCB EMERGENCY PHYSICIANS 98110706 HC PR 24535 TREAT HUMERUS FRACTURE W/MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 24535 $2,827.03CC WCB EMERGENCY PHYSICIANS 98110707 HC PR 24560 TREAT HUMERUS EPICOND FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24560 $1,100.58CC WCB EMERGENCY PHYSICIANS 98110707 HC PR 24560 TREAT HUMERUS EPICOND FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24560 $1,298.42CC WCB EMERGENCY PHYSICIANS 98110709 HC PR 24576 TREAT HUMERUS CONDYLAR FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24576 $933.50CC WCB EMERGENCY PHYSICIANS 98110711 HC PR 24577 TREAT HUMERUS CONDYLAR FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 24577 $2,330.34CC WCB EMERGENCY PHYSICIANS 98110713 HC PR 24600 TREAT ELBOW DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 24600 $1,033.52CC WCB EMERGENCY PHYSICIANS 98110713 HC PR 24600 TREAT ELBOW DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 24600 $1,038.32CC WCB EMERGENCY PHYSICIANS 98110714 HC PR 24605 TREAT ELBOW DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 24605 $1,276.68CC WCB EMERGENCY PHYSICIANS 98110716 HC PR 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 24640 $428.04CC WCB EMERGENCY PHYSICIANS 98110716 HC PR 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 24640 $493.15CC WCB EMERGENCY PHYSICIANS 98110718 HC PR 24650 TREAT RADIUS FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24650 $888.42CC WCB EMERGENCY PHYSICIANS 98110718 HC PR 24650 TREAT RADIUS FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24650 $951.97CC WCB EMERGENCY PHYSICIANS 98110720 HC PR 24655 CLOSED TX RADIUS HD FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24655 $344.25CC WCB EMERGENCY PHYSICIANS 98110721 HC 99225 PR SBSQ OBSERVATION CARE/DAY 25 MINUTES [99225 PROCEDURE ER MAIN-Profees ACTIVE 99225 $198.65CC WCB EMERGENCY PHYSICIANS 98110722 HC PR 24670 TREAT ULNAR FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24670 $1,144.64CC WCB EMERGENCY PHYSICIANS 98110722 HC PR 24670 TREAT ULNAR FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24670 $1,142.36CC WCB EMERGENCY PHYSICIANS 98110724 HC PR 24675 TREAT ULNAR FRACTURE W/MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 24675 $544.48CC WCB EMERGENCY PHYSICIANS 98110726 HC PR 25260 REPAIR FOREARM TENDON/MUSCLE PROCEDURE ER MAIN-Profees ACTIVE 0981 25260 $120.41CC WCB EMERGENCY PHYSICIANS 98110730 HC PR 25500 TREAT FRACTUE OF RADIUS W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0975 25500 $865.11CC WCB EMERGENCY PHYSICIANS 98110730 HC PR 25500 TREAT FRACTUE OF RADIUS W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0975 25500 $1,046.64CC WCB EMERGENCY PHYSICIANS 98110734 HC PR 25530 TREAT FRACTURE OF ULNA PROCEDURE ER MAIN-Profees ACTIVE 0981 25530 $875.47CC WCB EMERGENCY PHYSICIANS 98110734 HC PR 25530 TREAT FRACTURE OF ULNA PROCEDURE ER MAIN-Profees ACTIVE 0981 25530 $928.04CC WCB EMERGENCY PHYSICIANS 98110738 HC PR 25560 TREAT FRACTURE OF RADIUS AND ULNA W/O MANIPPROCEDURE ER MAIN-Profees ACTIVE 0981 25560 $927.18CC WCB EMERGENCY PHYSICIANS 98110738 HC PR 25560 TREAT FRACTURE OF RADIUS AND ULNA W/O MANIPPROCEDURE ER MAIN-Profees ACTIVE 0981 25560 $1,076.81CC WCB EMERGENCY PHYSICIANS 98110740 HC PR 25565 TREAT FRACTURE RADIUS & ULNA W/MANIPULATIO PROCEDURE ER MAIN-Profees ACTIVE 0981 25565 $2,041.28CC WCB EMERGENCY PHYSICIANS 98110742 HC PR 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 25600 $978.33CC WCB EMERGENCY PHYSICIANS 98110742 HC PR 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 25600 $1,136.12CC WCB EMERGENCY PHYSICIANS 98110744 HC PR 25605 TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 25605 $2,110.99CC WCB EMERGENCY PHYSICIANS 98110744 HC PR 25605 TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 25605 $2,185.88CC WCB EMERGENCY PHYSICIANS 98110746 HC PR 25622 TREAT WRIST BONE FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25622 $1,030.05CC WCB EMERGENCY PHYSICIANS 98110746 HC PR 25622 TREAT WRIST BONE FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25622 $1,196.46CC WCB EMERGENCY PHYSICIANS 98110750 HC PR 25630 TREAT CARPAL BONE FRACTURE W/O MANIP EACH BPROCEDURE ER MAIN-Profees ACTIVE 0981 25630 $1,030.05CC WCB EMERGENCY PHYSICIANS 98110754 HC PR 25650 TREAT ULNAR STYLOID FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25650 $1,153.93CC WCB EMERGENCY PHYSICIANS 98110754 HC PR 25650 TREAT ULNAR STYLOID FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25650 $1,326.51

CC WCB EMERGENCY PHYSICIANS 98110763 HC PR 26350 REPAIR FINGER/HAND TENDON PROCEDURE ER MAIN-Profees ACTIVE 0981 26350 $3,389.82CC WCB EMERGENCY PHYSICIANS 98110767 HC PR 26418 REPAIR OF EXTENSOR TENDON FINGER W/O GRAFT PROCEDURE ER MAIN-Profees ACTIVE 0981 26418 $2,312.30CC WCB EMERGENCY PHYSICIANS 98110771 HC PR 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26600 $798.81CC WCB EMERGENCY PHYSICIANS 98110771 HC PR 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26600 $891.62CC WCB EMERGENCY PHYSICIANS 98110773 HC PR 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26605 $1,198.19CC WCB EMERGENCY PHYSICIANS 98110773 HC PR 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26605 $1,336.91CC WCB EMERGENCY PHYSICIANS 98110775 HC PR 26641 TREAT CARPOMETACARPAL DISLOCATION W/MANIPPROCEDURE ER MAIN-Profees ACTIVE 0981 26641 $1,066.41CC WCB EMERGENCY PHYSICIANS 98110781 HC PR 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26700 $751.59CC WCB EMERGENCY PHYSICIANS 98110781 HC PR 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26700 $1,120.51CC WCB EMERGENCY PHYSICIANS 98110782 HC PR 26705 TREAT KNUCKLE DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26705 $1,089.46CC WCB EMERGENCY PHYSICIANS 98110783 HC PR 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER O PROCEDURE ER MAIN-Profees ACTIVE 0981 26720 $544.73CC WCB EMERGENCY PHYSICIANS 98110783 HC PR 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER O PROCEDURE ER MAIN-Profees ACTIVE 0981 26720 $608.63CC WCB EMERGENCY PHYSICIANS 98110786 HC PR 26725 CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER O PROCEDURE ER MAIN-Profees ACTIVE 0981 26725 $944.11CC WCB EMERGENCY PHYSICIANS 98110788 HC PR 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26740 $835.13CC WCB EMERGENCY PHYSICIANS 98110788 HC PR 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26740 $932.20CC WCB EMERGENCY PHYSICIANS 98110790 HC PR 26742 CLOSED TX ARTICULAR FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26742 $1,277.75CC WCB EMERGENCY PHYSICIANS 98110792 HC PR 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FINGER/ PROCEDURE ER MAIN-Profees ACTIVE 0981 26750 $472.36CC WCB EMERGENCY PHYSICIANS 98110792 HC PR 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FINGER/ PROCEDURE ER MAIN-Profees ACTIVE 0981 26750 $526.44CC WCB EMERGENCY PHYSICIANS 98110794 HC PR 26755 CLOSED TX DISTAL PHALANGEAL FRACTURE FINGER/ PROCEDURE ER MAIN-Profees ACTIVE 0981 26755 $726.39CC WCB EMERGENCY PHYSICIANS 98110795 HC PR 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/TH PROCEDURE ER MAIN-Profees ACTIVE 0981 26765 $2,033.32CC WCB EMERGENCY PHYSICIANS 98110795 HC PR 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/TH PROCEDURE ER MAIN-Profees ACTIVE 0981 26765 $2,269.11CC WCB EMERGENCY PHYSICIANS 98110798 HC PR 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26770 $508.42CC WCB EMERGENCY PHYSICIANS 98110798 HC PR 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26770 $568.06CC WCB EMERGENCY PHYSICIANS 98110800 HC PR 26775 CLOSED TX FINGER DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26775 $762.76CC WCB EMERGENCY PHYSICIANS 98110800 HC PR 26775 CLOSED TX FINGER DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26775 $851.05CC WCB EMERGENCY PHYSICIANS 98110808 HC PR 58301 REMOVE INTRAUTERINE DEVICE PROCEDURE ER MAIN-Profees ACTIVE 0981 58301 $174.01CC WCB EMERGENCY PHYSICIANS 98110808 HC PR 58301 REMOVE INTRAUTERINE DEVICE PROCEDURE ER MAIN-Profees ACTIVE 0981 58301 $174.79CC WCB EMERGENCY PHYSICIANS 98110812 HC PR 62270 SPINAL FLUID TAP DIAGNOSTIC PROCEDURE ER MAIN-Profees ACTIVE 0981 62270 $429.93CC WCB EMERGENCY PHYSICIANS 98110812 HC PR 62270 SPINAL FLUID TAP DIAGNOSTIC PROCEDURE ER MAIN-Profees ACTIVE 0981 62270 $488.99CC WCB EMERGENCY PHYSICIANS 98110814 HC PR 64400 NERVE BLOCK INJ TRIGEMINAL PROCEDURE ER MAIN-Profees ACTIVE 0981 64400 $384.95CC WCB EMERGENCY PHYSICIANS 98110817 HC PR 64450 NERVE BLOCK OTHER PERIPHERAL PROCEDURE ER MAIN-Profees ACTIVE 0981 64450 $495.41CC WCB EMERGENCY PHYSICIANS 98110818 HC PR 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL PROCEDURE ER MAIN-Profees ACTIVE 0981 65205 $238.99CC WCB EMERGENCY PHYSICIANS 98110818 HC PR 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL PROCEDURE ER MAIN-Profees ACTIVE 0981 65205 $243.45CC WCB EMERGENCY PHYSICIANS 98110819 HC PR 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED PROCEDURE ER MAIN-Profees ACTIVE 0981 65210 $259.13CC WCB EMERGENCY PHYSICIANS 98110819 HC PR 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED PROCEDURE ER MAIN-Profees ACTIVE 0981 65210 $264.26CC WCB EMERGENCY PHYSICIANS 98110820 HC PR 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O S PROCEDURE ER MAIN-Profees ACTIVE 0981 65220 $279.02CC WCB EMERGENCY PHYSICIANS 98110820 HC PR 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O S PROCEDURE ER MAIN-Profees ACTIVE 0981 65220 $284.03CC WCB EMERGENCY PHYSICIANS 98110821 HC PR 65222 REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SL PROCEDURE ER MAIN-Profees ACTIVE 0981 65222 $307.94CC WCB EMERGENCY PHYSICIANS 98110821 HC PR 65222 REMOVE FOREIGN BODY FROM EYE CORNEAL W/ SL PROCEDURE ER MAIN-Profees ACTIVE 0981 65222 $390.15CC WCB EMERGENCY PHYSICIANS 98110830 HC PR 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHES PROCEDURE ER MAIN-Profees ACTIVE 0981 69200 $321.20CC WCB EMERGENCY PHYSICIANS 98110830 HC PR 69200 CLEAR OUTER EAR CANAL W/O GENERAL ANESTHES PROCEDURE ER MAIN-Profees ACTIVE 0981 69200 $378.71CC WCB EMERGENCY PHYSICIANS 98110831 HC PR 69210 REMOVE IMPACTED EAR WAX PROCEDURE ER MAIN-Profees ACTIVE 0981 69210 $128.62CC WCB EMERGENCY PHYSICIANS 98110831 HC PR 69210 REMOVE IMPACTED EAR WAX PROCEDURE ER MAIN-Profees ACTIVE 0981 69210 $151.90CC WCB EMERGENCY PHYSICIANS 98110835 HC PR 26951 AMPUTATE FINGER/THUMB SINGLE W/DIRECT CLOSPROCEDURE ER MAIN-Profees ACTIVE 0981 26951 $2,369.87CC WCB EMERGENCY PHYSICIANS 98110844 HC PR 27230 TX THIGH FRACTURE PROX END NECK W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27230 $1,443.50CC WCB EMERGENCY PHYSICIANS 98110851 HC PR 27252 CLOSED TX HIP DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 27252 $1,974.98CC WCB EMERGENCY PHYSICIANS 98110854 HC PR 27265 TX POST HIP ARTHROPLASTY DISLOCATION W/O ANEPROCEDURE ER MAIN-Profees ACTIVE 0981 27265 $1,403.01CC WCB EMERGENCY PHYSICIANS 98110855 HC PR 27266 TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTPROCEDURE ER MAIN-Profees ACTIVE 0981 27266 $3,021.70CC WCB EMERGENCY PHYSICIANS 98110866 HC PR 27500 CLOSED TREAT FEMORAL SHAFT FRACTURE W/O MAPROCEDURE ER MAIN-Profees ACTIVE 0981 27500 $1,859.36CC WCB EMERGENCY PHYSICIANS 98110869 HC PR 27502 CL TX OF FEMORAL SHAFT FX W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27502 $2,728.65CC WCB EMERGENCY PHYSICIANS 98110871 HC PR 27508 TREAT FEMORAL FRACTURE W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 27508 $1,637.36CC WCB EMERGENCY PHYSICIANS 98110873 HC PR 27520 CLOSED TREAT PATELLAR FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27520 $968.80CC WCB EMERGENCY PHYSICIANS 98110873 HC PR 27520 CLOSED TREAT PATELLAR FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27520 $1,303.62CC WCB EMERGENCY PHYSICIANS 98110876 HC PR 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 27530 $1,255.21CC WCB EMERGENCY PHYSICIANS 98110876 HC PR 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 27530 $1,730.19

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CC WCB EMERGENCY SERVICES 45010254 HC ED REMOVE HIP FOREIGN BODY CDM PROCEDURE ER MAIN ACTIVE 0450 27087 $2,794.95CC WCB EMERGENCY SERVICES 45010257 HC ED TX THIGH FRACTURE PROX END NECK W/O MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 27230 $1,698.10CC WCB EMERGENCY SERVICES 45010267 HC ED CLOSED TX HIP DISLOCATION W/ANESTH CDM PROCEDURE ER MAIN ACTIVE 0450 27252 $2,194.53CC WCB EMERGENCY SERVICES 45010271 HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/O ANESTH C PROCEDURE ER MAIN ACTIVE 0450 27265 $2,004.30CC WCB EMERGENCY SERVICES 45010275 HC ED TX POST HIP ARTHROPLASTY DISLOCATION W/ANESTH CDMPROCEDURE ER MAIN ACTIVE 0450 27266 $3,554.75CC WCB EMERGENCY SERVICES 45010294 HC ED TREATMENT OF THIGH FRACTURE W/MANIPULATION CDMPROCEDURE ER MAIN ACTIVE 0450 27502 $3,031.80CC WCB EMERGENCY SERVICES 45010297 HC ED TREAT FEMORAL FRACTURE W/O MANIPULATION CDM PROCEDURE ER MAIN ACTIVE 0450 27508 $1,819.27CC WCB EMERGENCY SERVICES 45010308 HC ED INSERT NEEDLE BONE CAVITY CDM PROCEDURE ER MAIN ACTIVE 0450 36680 $802.54CC WCB EMERGENCY SERVICES 45010309 HC ED DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE CDM PROCEDURE ER MAIN ACTIVE 0450 10060 $457.47CC WCB EMERGENCY SERVICES 45010310 HC ED DRAINAGE OF SKIN ABSCESS COMPLICATED OR MULTIPLE CPROCEDURE ER MAIN ACTIVE 0450 10061 $618.22CC WCB EMERGENCY SERVICES 45010311 HC ED DRAINAGE OF PILONIDAL CYST SIMPLE CDM PROCEDURE ER MAIN ACTIVE 0450 10080 $490.62CC WCB EMERGENCY SERVICES 45010313 HC ED REMOVE FOREIGN BODY SIMPLE CDM PROCEDURE ER MAIN ACTIVE 0450 10120 $309.26CC WCB EMERGENCY SERVICES 45010314 HC ED REMOVE FOREIGN BODY COMPLICATED CDM PROCEDURE ER MAIN ACTIVE 0450 10121 $706.50CC WCB EMERGENCY SERVICES 45010316 HC ED DRAINAGE OF HEMA/FLUID CDM PROCEDURE ER MAIN ACTIVE 0450 10140 $700.94CC WCB EMERGENCY SERVICES 45010321 HC ED DEB SKIN BONE AT FX SITE CDM PROCEDURE ER MAIN ACTIVE 0450 11012 $2,097.22CC WCB EMERGENCY SERVICES 45010324 HC ED DEB SUBQ TISSUE 20 SQ CM/< - DEBRIDE SKIN CDM PROCEDURE ER MAIN ACTIVE 0450 11042 $442.12CC WCB EMERGENCY SERVICES 45010325 HC ED DEB MUSC/FASCIA 20 SQ CM/< CDM PROCEDURE ER MAIN ACTIVE 0450 11043 $728.28CC WCB EMERGENCY SERVICES 45010327 HC ED DEB BONE 20 SQ CM/< CDM PROCEDURE ER MAIN ACTIVE 0450 11044 $442.12CC WCB EMERGENCY SERVICES 45010348 HC ED REMOVAL OF NAIL PLATE CDM PROCEDURE ER MAIN ACTIVE 0450 11730 $178.25CC WCB EMERGENCY SERVICES 45010351 HC ED REMOVAL OF NAIL BED CDM PROCEDURE ER MAIN ACTIVE 0450 11750 $475.78CC WCB EMERGENCY SERVICES 45010355 HC ED REPAIR SUPERFICIAL WOUND(S)< 2.5CM SLP NK AX EXGEN PROCEDURE ER MAIN ACTIVE 0450 12001 $405.76CC WCB EMERGENCY SERVICES 45010356 HC ED REPAIR SUPERFICIAL WOUND(S) 2.6 TO 7.5CM SLP NK AX EX PROCEDURE ER MAIN ACTIVE 0450 12002 $490.37CC WCB EMERGENCY SERVICES 45010357 HC ED REPAIR SUPERFICIAL WOUND(S)7.6 TO 12.5CM SLP NK AX E PROCEDURE ER MAIN ACTIVE 0450 12004 $608.63CC WCB EMERGENCY SERVICES 45010358 HC ED REPAIR SUPERFICIAL WOUND(S)12.6 TO 20.0CM SLP NK AX PROCEDURE ER MAIN ACTIVE 0450 12005 $642.35CC WCB EMERGENCY SERVICES 45010359 HC ED REPAIR SUPERFICIAL WOUND(S) 20.1-30.0CM SLP NK AX EX PROCEDURE ER MAIN ACTIVE 0450 12006 $777.34CC WCB EMERGENCY SERVICES 45010360 HC ED REPAIR SUPERFICIAL WOUND(S) >30CM SLP NK AX EXGEN T PROCEDURE ER MAIN ACTIVE 0450 12007 $1,096.50CC WCB EMERGENCY SERVICES 45010361 HC ED REPAIR SUPERFICIAL WOUND(S) <2.5 FACE ERS EYLD NSE LP PROCEDURE ER MAIN ACTIVE 0450 12011 $490.37CC WCB EMERGENCY SERVICES 45010362 HC ED REPAIR SUPERFICIAL WOUND(S) 2.6 TO 5.0CM FACE ERS EY PROCEDURE ER MAIN ACTIVE 0450 12013 $574.72CC WCB EMERGENCY SERVICES 45010363 HC ED REPAIR SUPERFICIAL WOUND(S) 5.1 TO 7.5CM FACE ERS EY PROCEDURE ER MAIN ACTIVE 0450 12014 $659.33CC WCB EMERGENCY SERVICES 45010364 HC ED REPAIR SUPERFICIAL WOUND(S) 7.6 TO 12.5CM FACE ERS E PROCEDURE ER MAIN ACTIVE 0450 12015 $861.90CC WCB EMERGENCY SERVICES 45010365 HC ED REPAIR SUPERFICIAL WOUND(S) 12.6 TO 20.0CM FACE ERS PROCEDURE ER MAIN ACTIVE 0450 12016 $1,064.52CC WCB EMERGENCY SERVICES 45010367 HC ED REPAIR SUPERFICIAL WOUND(S) 20.1 TO 30.0CM FACE ERS PROCEDURE ER MAIN ACTIVE 0450 12017 $2,129.05CC WCB EMERGENCY SERVICES 45010372 HC ED INTMD WND REPAIR S/TR/EXT UP TO 2.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12031 $466.50CC WCB EMERGENCY SERVICES 45010373 HC ED INTMD WND REPAIR S/TR/EXT 2.6 TO 7.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12032 $602.00CC WCB EMERGENCY SERVICES 45010374 HC ED INTMD WND REPAIR S/TR/EXT 7.6 TO 12.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12034 $677.33CC WCB EMERGENCY SERVICES 45010375 HC ED INTMD WND REPAIR S/TR/EXT 12.6 TO 20.0CM CDM PROCEDURE ER MAIN ACTIVE 0450 12035 $917.90CC WCB EMERGENCY SERVICES 45010376 HC ED INTMD WND REPAIR S/TR/EXT 20.1 TO 30.0CM CDM PROCEDURE ER MAIN ACTIVE 0450 12036 $1,188.66CC WCB EMERGENCY SERVICES 45010377 HC ED INTMD WND REPAIR S/TR/EXT > 30 CM. CDM PROCEDURE ER MAIN ACTIVE 0450 12037 $1,454.62CC WCB EMERGENCY SERVICES 45010378 HC ED INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12041 $556.92CC WCB EMERGENCY SERVICES 45010380 HC ED INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12042 $602.00CC WCB EMERGENCY SERVICES 45010381 HC ED INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12044 $782.65CC WCB EMERGENCY SERVICES 45010382 HC ED INTMD WND REPAIR N-HG/GENIT 12.6 TO 20.0CM CDM PROCEDURE ER MAIN ACTIVE 0450 12045 $1,324.16CC WCB EMERGENCY SERVICES 45010385 HC ED INTMD WND REPAIR FACE/MM <2.5 CM CDM PROCEDURE ER MAIN ACTIVE 0450 12051 $677.33CC WCB EMERGENCY SERVICES 45010386 HC ED INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM CDM PROCEDURE ER MAIN ACTIVE 0450 12052 $752.66CC WCB EMERGENCY SERVICES 45010387 HC ED INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12053 $993.17CC WCB EMERGENCY SERVICES 45010388 HC ED INTMD WND REPAIR FACE/MM 7.5 TO 12.5CM CDM PROCEDURE ER MAIN ACTIVE 0450 12054 $1,293.92CC WCB EMERGENCY SERVICES 45010389 HC ED INTMD WND REPAIR FACE/MM 12.6 TO 20.0CM CDM PROCEDURE ER MAIN ACTIVE 0450 12055 $1,655.15CC WCB EMERGENCY SERVICES 45010392 HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX, TR PROCEDURE ER MAIN ACTIVE 0450 13100 $496.74CC WCB EMERGENCY SERVICES 45010393 HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, TR PROCEDURE ER MAIN ACTIVE 0450 13101 $888.73CC WCB EMERGENCY SERVICES 45010395 HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMPLEX, SC PROCEDURE ER MAIN ACTIVE 0450 13120 $784.23CC WCB EMERGENCY SERVICES 45010396 HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMPLEX, SC PROCEDURE ER MAIN ACTIVE 0450 13121 $1,202.43CC WCB EMERGENCY SERVICES 45010398 HC ED REPAIR WOUND/LESION ADD-ON 5CM OR LESS COMPLEX, PROCEDURE ER MAIN ACTIVE 0450 13122 $483.74CC WCB EMERGENCY SERVICES 45010399 HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX, FRHD PROCEDURE ER MAIN ACTIVE 0450 13131 $914.94CC WCB EMERGENCY SERVICES 45010405 HC ED REMOVE RECTAL OBSTRUCTION CDM PROCEDURE ER MAIN ACTIVE 0450 45915 $844.97CC WCB EMERGENCY SERVICES 45010410 HC ED INCISE EXTERNAL HEMORRHOID CDM PROCEDURE ER MAIN ACTIVE 0450 46083 $447.17

CC WCB EMERGENCY SERVICES 45010412 HC ED REMOVE EXT HEM GROUPS 2+ CDM PROCEDURE ER MAIN ACTIVE 0450 46250 $1,683.77CC WCB EMERGENCY SERVICES 45010414 HC ED DIAGNOSTIC ANOSCOPY CDM PROCEDURE ER MAIN ACTIVE 0450 46600 $330.99CC WCB EMERGENCY SERVICES 45010415 HC ED ANOSCOPY REMOVE FOR BODY CDM PROCEDURE ER MAIN ACTIVE 0450 46608 $424.88CC WCB EMERGENCY SERVICES 45010424 HC ED INSERT BLADDER CATH COMPLEX CDM PROCEDURE ER MAIN ACTIVE 0450 51703 $489.04CC WCB EMERGENCY SERVICES 45010448 HC ED REMOVE VAGINAL FOREIGN BODY CDM PROCEDURE ER MAIN ACTIVE 0450 57415 $693.24CC WCB EMERGENCY SERVICES 45010455 HC ED REMOVE INTRAUTERINE DEVICE CDM PROCEDURE ER MAIN ACTIVE 0450 58301 $193.09CC WCB EMERGENCY SERVICES 45010459 HC ED NERVE BLOCK INJ TRIGEMINAL CDM PROCEDURE ER MAIN ACTIVE 0450 64400 $452.88CC WCB EMERGENCY SERVICES 45010467 HC ED REMOVE FOREIGN BODY FROM EYE SUPERFICIAL CDM PROCEDURE ER MAIN ACTIVE 0450 65205 $265.51CC WCB EMERGENCY SERVICES 45010469 HC ED REMOVE FOREIGN BODY FROM EYE EMBEDDED CDM PROCEDURE ER MAIN ACTIVE 0450 65210 $287.74CC WCB EMERGENCY SERVICES 45010471 HC ED REMOVE FOREIGN BODY FROM EYE CORNEAL W/O SLIT LA PROCEDURE ER MAIN ACTIVE 0450 65220 $310.03CC WCB EMERGENCY SERVICES 45010489 HC ED CLEAR OUTER EAR CANAL W/O GENERAL ANESTHESIA CDMPROCEDURE ER MAIN ACTIVE 0450 69200 $357.00CC WCB EMERGENCY SERVICES 45010491 HC ED REMOVE IMPACTED EAR WAX CDM PROCEDURE ER MAIN ACTIVE 0450 69210 $142.95CC WCB EMERGENCY SERVICES 45010492 HC ED DRAINAGE OF GUM LESION CDM PROCEDURE ER MAIN ACTIVE 0450 41800 $494.60CC WCB EMERGENCY SERVICES 45010496 HC ED CLOSED TREAT PATELLAR FRACTURE W/O MANIPULATION PROCEDURE ER MAIN ACTIVE 0450 27520 $1,076.46CC WCB EMERGENCY SERVICES 45010499 HC ED CLOSED TREAT TIBIAL FRACTURE PROXIMAL W/O MANIP C PROCEDURE ER MAIN ACTIVE 0450 27530 $1,394.70CC WCB EMERGENCY SERVICES 45010501 HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX, FRHD PROCEDURE ER MAIN ACTIVE 0450 13132 $1,777.15CC WCB EMERGENCY SERVICES 45010502 HC ED REPAIR WOUND/LESION ADD-ON 5CM CMPLX, FRHD CKS S PROCEDURE ER MAIN ACTIVE 0450 13133 $705.99CC WCB EMERGENCY SERVICES 45010504 HC ED REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX EYLD PROCEDURE ER MAIN ACTIVE 0450 13151 $1,150.20CC WCB EMERGENCY SERVICES 45010505 HC ED REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX EYLD PROCEDURE ER MAIN ACTIVE 0450 13152 $2,247.57CC WCB EMERGENCY SERVICES 45010506 HC ED REPAIR WOUND/LESION ADD-ON 5CM CMPLX EYLD NS ERS PROCEDURE ER MAIN ACTIVE 0450 13153 $1,481.70CC WCB EMERGENCY SERVICES 45010518 HC ED INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX CDM PROCEDURE ER MAIN ACTIVE 0450 16000 $157.54CC WCB EMERGENCY SERVICES 45010519 HC ED DRESS/DEBRID P-THICK BURN S <5% TBSA CDM PROCEDURE ER MAIN ACTIVE 0450 16020 $243.47CC WCB EMERGENCY SERVICES 45010520 HC ED DRESS/DEBRID P-THICK BURN M 5-10% TBSA CDM PROCEDURE ER MAIN ACTIVE 0450 16025 $386.43CC WCB EMERGENCY SERVICES 45010521 HC ED DRESS/DEBRID P-THICK BURN L >10% TBSA CDM PROCEDURE ER MAIN ACTIVE 0450 16030 $572.32CC WCB EMERGENCY SERVICES 45010530 HC ED EXPLORE WOUND NECK CDM PROCEDURE ER MAIN ACTIVE 0450 20100 $2,415.97CC WCB EMERGENCY SERVICES 45010533 HC ED EXPLORE WOUND EXTREMITY CDM PROCEDURE ER MAIN ACTIVE 0450 20103 $2,415.97CC WCB EMERGENCY SERVICES 45010534 HC ED REMOVAL OF FOREIGN BODY MUSC, SIMP CDM PROCEDURE ER MAIN ACTIVE 0450 20520 $469.97CC WCB EMERGENCY SERVICES 45010535 HC ED REMOVAL OF FOREIGN BODY COMPLEX CDM PROCEDURE ER MAIN ACTIVE 0450 20525 $1,181.21CC WCB EMERGENCY SERVICES 45010539 HC ED INJ TRIGGER POINT 1/2 MUSCL CDM PROCEDURE ER MAIN ACTIVE 0450 20552 $244.80CC WCB EMERGENCY SERVICES 45010545 HC ED TREATMENT OF NOSE FRACTURE W/O MANIPULATION CD PROCEDURE ER MAIN ACTIVE 0450 21310 $502.30CC WCB EMERGENCY SERVICES 45010550 HC ED CLOSED TREATMENT EYE SOCKET FRACTURE NON BLOWO PROCEDURE ER MAIN ACTIVE 0450 21400 $785.55CC WCB EMERGENCY SERVICES 45010554 HC ED TREAT LOWER JAW FRACTURE W/O MANIPULATION CDM PROCEDURE ER MAIN ACTIVE 0450 21450 $1,656.74CC WCB EMERGENCY SERVICES 45010556 HC ED RESET DISLOCATED JAW UNCOMPLICATED CDM PROCEDURE ER MAIN ACTIVE 0450 21480 $502.30CC WCB EMERGENCY SERVICES 45010566 HC ED TREAT CLAVICLE FRACTURE W/O MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 23500 $731.95CC WCB EMERGENCY SERVICES 45010568 HC ED DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM CDM PROCEDURE ER MAIN ACTIVE 0450 11045 $113.53CC WCB EMERGENCY SERVICES 45010576 HC ED TREAT CLAVICLE DISLOCATIONAC JT DISLO W/O MAN CDMPROCEDURE ER MAIN ACTIVE 0450 23540 $1,012.81CC WCB EMERGENCY SERVICES 45010581 HC ED TREAT SHOULDER BLADE FX W/O MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 23570 $871.49CC WCB EMERGENCY SERVICES 45010585 HC ED TREAT HUMERUS FRACTURE W/O MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 23600 $1,115.47CC WCB EMERGENCY SERVICES 45010590 HC ED TREAT HUMERUS FRACTURE TUBEROSITY W/O MAN CDM PROCEDURE ER MAIN ACTIVE 0450 23620 $1,063.76CC WCB EMERGENCY SERVICES 45010594 HC ED TREAT SHOULDER DISLOCATION W/MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 23650 $975.94CC WCB EMERGENCY SERVICES 45010596 HC ED TREAT SHOULDER DISLOCATION W/MANIP & ANNES CDM PROCEDURE ER MAIN ACTIVE 0450 23655 $1,463.90CC WCB EMERGENCY SERVICES 45010602 HC ED DRAINAGE OF ARM LESION CDM PROCEDURE ER MAIN ACTIVE 0450 23930 $1,324.16CC WCB EMERGENCY SERVICES 45010606 HC ED REMOVAL OF ARM FOREIGN BODY CDM PROCEDURE ER MAIN ACTIVE 0450 24200 $397.55CC WCB EMERGENCY SERVICES 45010609 HC ED DRAIN BLOOD FROM UNDER NAIL CDM PROCEDURE ER MAIN ACTIVE 0450 11740 $105.83CC WCB EMERGENCY SERVICES 45010621 HC ED TREAT KNUCKLE DISLOCATION CDM PROCEDURE ER MAIN ACTIVE 0450 26705 $1,210.38CC WCB EMERGENCY SERVICES 45010636 HC ED REPAIR FINGER/HAND TENDON CDM PROCEDURE ER MAIN ACTIVE 0450 26350 $3,766.40CC WCB EMERGENCY SERVICES 45010673 HC ED INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE C PROCEDURE ER MAIN ACTIVE 0450 64447 $673.61CC WCB EMERGENCY SERVICES 45010705 HC ED TREAT HUMERUS FX W/O MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 24500 $1,144.34CC WCB EMERGENCY SERVICES 45010706 HC ED STRAPPING UNNA BOOT CDM PROCEDURE ER MAIN ACTIVE 0450 29580 $177.99CC WCB EMERGENCY SERVICES 45010713 HC ED TREAT HUMERUS FRACTURE CDM PROCEDURE ER MAIN ACTIVE 0450 24530 $1,419.38CC WCB EMERGENCY SERVICES 45010717 HC ED TREAT HUMERUS FRACTURE W/MANIPULATION CDM PROCEDURE ER MAIN ACTIVE 0450 24535 $3,325.91CC WCB EMERGENCY SERVICES 45010722 HC ED TREAT HUMERUS EPICOND FRACTURE CDM PROCEDURE ER MAIN ACTIVE 0450 24560 $1,294.74CC WCB EMERGENCY SERVICES 45010723 HC ED RMVL TUN CVC W/O SUBQ PORT/PMP CDM PROCEDURE ER MAIN ACTIVE 0450 36589 $856.60CC WCB EMERGENCY SERVICES 45010730 HC ED TREAT HUMERUS CONDYLAR FRACTURE CDM PROCEDURE ER MAIN ACTIVE 0450 24576 $1,037.24CC WCB EMERGENCY SERVICES 45010734 HC ED TREAT HUMERUS CONDYLAR FRACTURE W/MANIPULATIO PROCEDURE ER MAIN ACTIVE 0450 24577 $2,589.17

CC WCB EMERGENCY SERVICES 45010738 HC ED TREAT ELBOW DISLOCATION W/O ANESTH CDM PROCEDURE ER MAIN ACTIVE 0450 24600 $1,215.69CC WCB EMERGENCY SERVICES 45010741 HC ED TREAT ELBOW DISLOCATION W/ANESTH CDM PROCEDURE ER MAIN ACTIVE 0450 24605 $1,501.85CC WCB EMERGENCY SERVICES 45010749 HC ED CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MANIP PROCEDURE ER MAIN ACTIVE 0450 24640 $475.78CC WCB EMERGENCY SERVICES 45010752 HC ED TREAT RADIUS FRACTURE CDM PROCEDURE ER MAIN ACTIVE 0450 24650 $1,045.19CC WCB EMERGENCY SERVICES 45010760 HC ED TREAT ULNAR FRACTURE CDM PROCEDURE ER MAIN ACTIVE 0450 24670 $1,346.45CC WCB EMERGENCY SERVICES 45010765 HC ED FETAL NONSTRESS TEST CDM PROCEDURE ER MAIN ACTIVE 0450 59025 $262.85CC WCB EMERGENCY SERVICES 45010767 HC ED SLCTV CATH PLMT VEN SYS 1ST ORDER BRANCH CDM PROCEDURE ER MAIN ACTIVE 0450 36011 $2,652.00CC WCB EMERGENCY SERVICES 45010778 HC ED TREAT FRACTURE OF RADIUS W/O MANIPULATION CDM PROCEDURE ER MAIN ACTIVE 0450 25500 $1,017.86CC WCB EMERGENCY SERVICES 45010783 HC ED ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US CDPROCEDURE ER MAIN ACTIVE 0450 20605 $228.38CC WCB EMERGENCY SERVICES 45010785 HC ED INSERTION OF CHEST TUBE CDM PROCEDURE ER MAIN ACTIVE 0450 32551 $884.44CC WCB EMERGENCY SERVICES 45010787 HC ED THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING CDM PROCEDURE ER MAIN ACTIVE 0450 32555 $1,986.91CC WCB EMERGENCY SERVICES 45010790 HC ED TREAT FRACTURE OF ULNA CDM PROCEDURE ER MAIN ACTIVE 0450 25530 $972.77CC WCB EMERGENCY SERVICES 45010798 HC ED TREAT FRACTURE OF RADIUS AND ULNA W/O MANIP CDM PROCEDURE ER MAIN ACTIVE 0450 25560 $1,030.05CC WCB EMERGENCY SERVICES 45010801 HC ED TREAT FRACTURE RADIUS & ULNA W/MANIPULATION CDMPROCEDURE ER MAIN ACTIVE 0450 25565 $2,401.39CC WCB EMERGENCY SERVICES 45010804 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/O MAN PROCEDURE ER MAIN ACTIVE 0450 25600 $1,087.07CC WCB EMERGENCY SERVICES 45010808 HC ED TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/MANIP PROCEDURE ER MAIN ACTIVE 0450 25605 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$16.62CC WCB FAMILY MED CLINIC 63610129 HC PR RX ZOSTER VACCINE HZV LIVE SQ 0.65 ML PROCEDURE Medications ACTIVE 0636 90736 $422.40CC WCB FAMILY MED CLINIC 63610135 HC PR RX VITAMIN B12 INJ 1000 MCG PROCEDURE Medications ACTIVE 0636 J3420 $9.36CC WCB FAMILY MED CLINIC 63610192 HC PR RX METHYLPREDNISOLONE ACETATE INJ 40 MG PROCEDURE Medications ACTIVE 0636 J1030 $37.45CC WCB FAMILY MED CLINIC 63610193 HC PR RX METHYLPREDNISOLONE ACETATE INJ 80 MG PROCEDURE Medications ACTIVE 0636 J1040 $55.14CC WCB FAMILY MED CLINIC 63610243 HC PR RX MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VAC PROCEDURE Medications ACTIVE 0636 90620 $162.31CC WCB FAMILY MED CLINIC 63610246 HC PR RX INFLUENZA QUADRIVALENT PF IM 0.5 ML PROCEDURE Medications ACTIVE 0636 90674 $52.02CC WCB FAMILY MED CLINIC 63610248 HC PR RX HZV ZOSTER VACCINE RECOMBINANT ADJUVANTED IM PROCEDURE Medications ACTIVE 0636 90750 $234.09CC WCB FAMILY MED CLINIC 63610250 HC PR RX TRIAMCINOLONE ACETATE INJ 10 MG PROCEDURE Medications ACTIVE 0636 J3301 $14.57

CC WCB FAMILY MED CLINIC 63610277 HC PR RX ALBUTEROL NON-COMPOUNDED CONCENTRATED UNIT PROCEDURE Medications ACTIVE 0636 J7613 $46.82CC WCB FAMILY MED CLINIC 63610278 HC PR RX CEFTRIAXONE SODIUM INJ 250 MG PROCEDURE Medications ACTIVE 0636 J0696 $9.36CC WCB FAMILY MED CLINIC 63610294 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACCINE < 7 YR PROCEDURE Medications ACTIVE 0636 90700 $23.15CC WCB FAMILY MED CLINIC 63610294 HC PR RX DIPHTH TETANUS TOX ACELL PERTUSSIS VACCINE < 7 YR PROCEDURE Medications ACTIVE 0636 90700 $54.10CC WCB FAMILY MED CLINIC 63610295 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML PROCEDURE Medications ACTIVE 0636 90723 $177.91CC WCB FAMILY MED CLINIC 63610295 HC PR RX DTAP-HEPB-IPV VACCINE IM 0.5 ML PROCEDURE Medications ACTIVE 0636 90723 $71.99CC WCB FAMILY MED CLINIC 63610296 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML PROCEDURE Medications ACTIVE 0636 90696 $67.63CC WCB FAMILY MED CLINIC 63610296 HC PR RX DTAP-IPV VACCINE CHILD 4-6 YRS IM 0.5 ML PROCEDURE 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PROCEDURE Medications ACTIVE 0636 J3030 $358.94CC WCB FAMILY MED CLINIC 63610545 HC PR RX DIPHENHYDRAMINE HCL INJ 50 MG PROCEDURE Medications ACTIVE 0636 J1200 $21.85CC WCB FAMILY MED CLINIC 63610546 HC PR RX ALBUTEROL NON-COMPOUNDED CONCENTRATED INH PROCEDURE Medications ACTIVE 0636 J7611 $4.43CC WCB FAMILY MED CLINIC 63610547 HC PR RX ALBUTEROL/IPRATROPIUM BROMIDE NON-COMPOUND PROCEDURE Medications ACTIVE 0636 J7620 $4.43CC WCB FAMILY MED CLINIC 77110229 HC PR ADMIN VACCINE INITIAL VFC PROCEDURE Injections ACTIVE 0771 90471 $23.91CC WCB FAMILY MED CLINIC 77110230 HC PR ADMIN VACCINE EA ADDL VFC PROCEDURE Injections ACTIVE 0771 90472 $23.91CC WCB FAMILY MED CLINIC 78010001 HC TELEHEALTH FACILITY FEE Q3014 PROCEDURE E & M ACTIVE 0780 Q3014 $48.90CC WCB FAMILY MED CLINIC 91410045 HC HEALTH & WELL-BEING COACHING F2F INDIV 1ST ASSMT CDMPROCEDURE All ACTIVE 0914 0591T $150.00CC WCB FAMILY MED CLINIC 91410046 HC HEALTH & WELL-BEING COACHING F2F INDIV F-UP SESS CDM PROCEDURE All ACTIVE 0914 0592T $134.65CC WCB FAMILY MED CLINIC 91510096 HC HEALTH & WELL-BEING COACHING FACE TO FACE GROUP CDMPROCEDURE All ACTIVE 0915 0593T $125.00CC WCB FAMILY MED CLINIC 94210089 HC MNT SUBS TX FOR CHANGE DX PROCEDURE E & M ACTIVE 0942 G0270 $45.90CC WCB FAMILY MED CLINIC 94210089 HC MNT SUBS TX FOR CHANGE DX PROCEDURE E & M ACTIVE 0942 G0270 $42.66CC WCB FAMILY MED CLINIC 96010015 HC PR 99406 BEHAV CHNG SMOKING 3-10 MIN PROCEDURE E & M-Profees ACTIVE 0960 99406 $108.20CC WCB FAMILY MED CLINIC 96010017 HC PR 99407 BEHAV CHNG SMOKING > 10 MIN PROCEDURE E & M-Profees ACTIVE 0960 99407 $137.33CC WCB FAMILY MED CLINIC 96010047 HC PR 99495 TRANSITIONAL CARE MANAGE SERVICE 14 DAY DISC PROCEDURE E & M-Profees ACTIVE 0960 99495 $383.91CC WCB FAMILY MED CLINIC 96010048 HC PR 99496 TRANSITIONAL CARE MANAGE SERVICE 7 DAY DISCH PROCEDURE E & M-Profees ACTIVE 0960 99496 $575.34CC WCB FAMILY MED CLINIC 96010066 HC PR 99487 CMPLX CHRON CARE MGMT W/O PT VST 1ST HR PER PROCEDURE E & M-Profees ACTIVE 0960 99487 $268.42CC WCB FAMILY MED CLINIC 96010067 HC PR 99489 CMPLX CHRON CARE MGMT EA ADDL 30 MIN PER M PROCEDURE E & M-Profees ACTIVE 0960 99489 $137.33CC WCB FAMILY MED CLINIC 96110077 HC PR 96127 BRIEF EMOTIONAL/BEHAV ASSMT PROCEDURE E & M-Profees ACTIVE 0961 96127 $46.82CC WCB FAMILY MED CLINIC 96110086 HC PR G0506 COMP ASSESS CARE PLAN CCM SVC PROCEDURE E & M-Profees ACTIVE 0961 G0506CC WCB FAMILY MED CLINIC 96310001 HC PR 90885 PSY EVALUATION OF RECORDS PROCEDURE E & M-Profees ACTIVE 0983 90885 $342.29CC WCB FAMILY MED CLINIC 96310002 HC PR 90887 CONSULTATION WITH FAMILY PROCEDURE E & M-Profees ACTIVE 0983 90887 $255.94CC WCB FAMILY MED CLINIC 96310232 HC PR 36569 INSERTION PICC W/O IMG GDN 5 YR/> PROCEDURE Anesthesia-Profees ACTIVE 0963 36569 $3,209.63CC WCB FAMILY MED CLINIC 96910001 HC PR 99075 MEDICAL TESTIMONY PROCEDURE PT/OT/ST-Profees ACTIVE 0983 99075 $374.54

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99315 $0.00CC WCB FAMILY MED CLINIC 96910108 HC PR 99315 NURSING FAC DISCHARGE DAY 30MIN/LESS PROCEDURE E & M-Profees ACTIVE 0983 99315 $192.47CC WCB FAMILY MED CLINIC 96910109 HC PR 99316 NURSING FAC DISCHARGE DAY 30MIN/MORE PROCEDURE E & M-Profees ACTIVE 0983 99316 $0.00CC WCB FAMILY MED CLINIC 96910109 HC PR 99316 NURSING FAC DISCHARGE DAY 30MIN/MORE PROCEDURE E & M-Profees ACTIVE 0983 99316 $240.33CC WCB FAMILY MED CLINIC 96910110 HC PR 99318 ANNUAL NURSING FAC ASSESSMNT PROCEDURE E & M-Profees ACTIVE 0983 99318 $0.00CC WCB FAMILY MED CLINIC 96910111 HC PR 99324 DOMICIL/R-HOME VISIT NEW PAT LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99324 $181.03CC WCB FAMILY MED CLINIC 96910112 HC PR 99325 DOMICIL/R-HOME VISIT NEW PAT LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99325 $240.33CC WCB FAMILY MED CLINIC 96910113 HC PR 99326 DOMICIL/R-HOME VISIT NEW PAT LEVEL 3 PROCEDURE E & M-Profees ACTIVE 0983 99326 $303.80CC WCB FAMILY MED CLINIC 96910115 HC PR 99335 DOMICIL/R-HOME VISIT EST PAT 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EXCISE/REPAIR MOUTH LESION PROCEDURE Surgical Procedure-Profee ACTIVE 0983 40812 $708.51CC WCB FAMILY MED CLINIC 96910300 HC PR 54060 EXCISION OF PENIS LESION(S) PROCEDURE Surgical Procedure-Profee ACTIVE 0983 54060 $904.11CC WCB FAMILY MED CLINIC 96910331 HC PR 92551 PURE TONE HEARING TEST AIR PROCEDURE PT/OT/ST-Profees ACTIVE 0983 92551 $43.70CC WCB FAMILY MED CLINIC 96910335 HC PR 99199 SPECIAL SERVICE/PROC/REPORT PROCEDURE E & M-Profees ACTIVE 0983 99199 $607.59CC WCB FAMILY MED CLINIC 96910343 HC PR G0008 MEDICARE ADMIN INFLUENZA VIRUS VAC PROCEDURE INJ/INF ACTIVE 0771 G0008 $43.70CC WCB FAMILY MED CLINIC 96910344 HC PR G0009 MEDICARE ADMIN PNEUMOCOCCAL VACCINE PROCEDURE INJ/INF ACTIVE 0771 G0009 $43.70CC WCB FAMILY MED CLINIC 96910369 HC PR 99327 NP AST LVG/FSTER CRE IV PROCEDURE E & M-Profees ACTIVE 0983 99327 $425.52CC WCB FAMILY MED CLINIC 96910381 HC PR 54050 DESTRUCTION PENIS LESION(S), SIMPLE PROCEDURE Surgical Procedure-Profee ACTIVE 0983 54050 $330.85

CC WCB FAMILY MED CLINIC 96910399 HC PR G0396 ALCOHOL/SUBS INTERV 15-30MN PROCEDURE E & M-Profees ACTIVE 0983 G0396 $169.59CC WCB FAMILY MED CLINIC 96910402 HC PR 99491 CHRONIC CARE MGMT SVC AT LEAST 30 MIN PER MOPROCEDURE E & M-Profees ACTIVE 0983 99491 $192.47CC WCB FAMILY MED CLINIC 96910419 HC PR A4561 PESSARY, NON RUBBER,ANY TYPE PROCEDURE Supply ACTIVE 0983 A4561 $80.11CC WCB FAMILY MED CLINIC 96910438 HC PR G0104 CA SCREEN; FLEXI SIGMOIDSCOPE PROCEDURE E & M-Profees ACTIVE 0983 G0104 $407.84CC WCB FAMILY MED CLINIC 96910453 HC PR 90889 PREPARATION OF REPORT PROCEDURE E & M-Profees ACTIVE 0969 90889 $243.45CC WCB FAMILY MED CLINIC 96910461 HC PR 90460 IMMU ADM ANY ROUTE 1ST VAC/TOX <18 YRS PROCEDURE INJ/INF-Profees ACTIVE 0983 90460 $21.85CC WCB FAMILY MED CLINIC 96910462 HC PR 90461 IMMU ADM ANY ROUTE ADDL VAC/TOX <18 YRS PROCEDURE INJ/INF-Profees ACTIVE 0983 90461 $21.85CC WCB FAMILY MED CLINIC 96910463 HC PR 90471 IMMUNIZATION ADMIN PROCEDURE INJ/INF-Profees ACTIVE 0771 90471 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WCB FAMILY MED CLINIC 96910473 HC PR 96368 THER/DIAG CONCURRENT INF PROCEDURE INJ/INF-Profees ACTIVE 0983 96368 $88.43CC WCB FAMILY MED CLINIC 96910474 HC PR 96372 THER/PROPH/DIAG INJ SC/IM PROCEDURE INJ/INF-Profees ACTIVE 0940 96372 $66.59CC WCB FAMILY MED CLINIC 96910475 HC PR 96374 THER/PROPH/DIAG INJ IV PUSH PROCEDURE Surgical Procedure-Profee ACTIVE 0983 96374 $208.08CC WCB FAMILY MED CLINIC 96910476 HC PR 96375 TX/PRO/DX INJ NEW DRUG ADDON PROCEDURE Surgical Procedure-Profee ACTIVE 0983 96375 $96.76CC WCB FAMILY MED CLINIC 96910485 HC PR 11404 EXC TR-EXT B9+MARG 3.1-4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11404 $838.56CC WCB FAMILY MED CLINIC 96910486 HC PR 11406 EXC TR-EXT B9+MARG > 4.0 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11406 $1,186.06CC WCB FAMILY MED CLINIC 96910489 HC PR 11421 EXC H-F-NK-SP B9+MARG 0.6-1 PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11421 $391.19CC WCB FAMILY MED CLINIC 96910490 HC PR 11424 EXC H-F-NK-SP B9+MARG 3.1-4 PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11424 $925.96CC WCB FAMILY MED CLINIC 96910492 HC PR 11441 EXC FACE-MM B9+MARG 0.6-1 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11441 $477.54CC WCB FAMILY MED CLINIC 96910493 HC PR 11450 REMOVAL SWEAT GLAND LESION AXIL PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11450 $1,735.39CC WCB FAMILY MED CLINIC 96910494 HC PR 11600 EXC TR-EXT MLG+MARG 0.5 < CM PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11600 $359.98CC WCB FAMILY MED CLINIC 96910495 HC PR 11601 EXC TR-EXT MLG+MARG 0.6-1 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11601 $395.35CC WCB FAMILY MED CLINIC 96910496 HC PR 11602 EXC TR-EXT MLG+MARG 1.1-2 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11602 $522.28CC WCB FAMILY MED CLINIC 96910497 HC PR 11719 TRIM NAIL(S) PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11719 $74.91CC WCB FAMILY MED CLINIC 96910498 HC PR 11721 DEBRIDE NAIL 6 OR MORE PROCEDURE Surgical Procedure-Profee ACTIVE 0983 11721 $101.96CC WCB FAMILY 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DRAIN NECK/CHEST LESION PROCEDURE Surgical Procedure-Profee ACTIVE 0983 21501 $1,504.42CC WCB FAMILY MED CLINIC 96910543 HC PR 94640 NEBULIZER SMALL VOLUME PROCEDURE Resp Ther-Profees ACTIVE 0410 94640 $58.34CC WCB FAMILY MED CLINIC 96910543 HC PR 94640 NEBULIZER SMALL VOLUME PROCEDURE Resp Ther-Profees ACTIVE 0410 94640 $63.46CC WCB FAMILY MED CLINIC 96910601 HC PR 59025 FETAL NON-STRESS TEST PROCEDURE L & D-Profees ACTIVE 0983 59025 $267.38CC WCB FAMILY MED CLINIC 96910609 HC PR 59410 VAG DELIVERY W/POSTPARTUM PROCEDURE L & D-Profees ACTIVE 0983 59410 $0.00CC WCB FAMILY MED CLINIC 96910628 HC PR 59430 POSTPARTUM CARE ONLY PROCEDURE Nursing-Profees ACTIVE 0983 59430 $318.36CC WCB FAMILY MED CLINIC 96910630 HC PR 99460 NEWBORN CARE PROCEDURE Nursing-Profees ACTIVE 0983 99460 $519.16CC WCB FAMILY MED CLINIC 96910631 HC PR 99462 NEWBORN HOSPITAL VISIT PROCEDURE Nursing-Profees ACTIVE 0983 99462 $242.41CC WCB FAMILY MED CLINIC 96910639 HC PR 90473 IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX 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CLINIC 96910804 HC PR 54161 CIRCUMCISION 28 DAYS OR OLDER PROCEDURE Surgical Procedure-Profee ACTIVE 0983 54161 $2,209.81

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HI RISK IND PROCEDURE E & M-Profees ACTIVE 0975 G0105 $1,524.19CC WCB FAMILY MED CLINIC 97510013 HC PR G0121 COLORECTAL SCRN; NOT HI RISK IND PROCEDURE E & M-Profees ACTIVE 0975 G0121 $1,524.19CC WCB FAMILY MED CLINIC 97510016 HC PR 97597 RMVL DEVITAL TIS 20 CM/< PROCEDURE PT/OT/ST-Profees ACTIVE 0981 97597 $146.70CC WCB FAMILY MED CLINIC 97510019 HC PR 10021 FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LES PROCEDURE Surgical Procedure-Profee ACTIVE 0975 10021 $268.42CC WCB FAMILY MED CLINIC 97510021 HC PR 10040 ACNE SURGERY PROCEDURE Surgical Procedure-Profee ACTIVE 0975 10040 $253.86CC WCB FAMILY MED CLINIC 97510038 HC PR 11055 TRIM SKIN LESION PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11055 $84.27CC WCB FAMILY MED CLINIC 97510039 HC PR 11056 TRIM SKIN LESIONS 2 TO 4 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11056 $107.16CC WCB FAMILY MED CLINIC 97510044 HC PR 11200 REMOVAL OF SKIN TAGS PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11200 $254.90CC WCB FAMILY MED CLINIC 97510045 HC PR 11201 REMOVE SKIN TAGS ADD-ON PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11201 $147.74CC WCB FAMILY MED CLINIC 97510046 HC PR 11300 SHAVE SKIN LESION 0.5 CM OR LESS TRNK ARM LEG PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11300 $174.79CC WCB FAMILY MED CLINIC 97510048 HC PR 11301 SHAVE SKIN LESION 0.6 TO 1.0 CM TRNK ARM LEG PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11301 $215.36CC WCB FAMILY MED CLINIC 97510050 HC PR 11302 SHAVE SKIN LESION 1.1 TO 2.0 CM TRNK ARM LEG PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11302 $346.45CC WCB FAMILY MED CLINIC 97510053 HC PR 11303 SHAVE SKIN LESION OVER 2.0 CM TRNK ARM LEG PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11303 $346.45CC WCB FAMILY MED CLINIC 97510056 HC PR 11307 SHAVE SKIN LESION 1.1 TO 2.0 CM SCLP NK HND FT GPROCEDURE Surgical Procedure-Profee ACTIVE 0975 11307 $268.42CC WCB FAMILY MED CLINIC 97510058 HC PR 11308 SHAVE SKIN LESION OVER 2.0 CM SCLP NK HND FT G PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11308 $309.00CC WCB FAMILY MED CLINIC 97510060 HC PR 11310 SHAVE SKIN LESION 0.5 CM OR LESS FACE ERS EYLD PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11310 $215.36CC WCB FAMILY MED CLINIC 97510063 HC PR 11311 SHAVE SKIN LESION 0.6 TO 1.0 CM FACE ERS EYLD NS PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11311 $254.90CC WCB FAMILY MED CLINIC 97510065 HC PR 11312 SHAVE SKIN LESION 1.1 TO 2.0 CM FACE ERS EYLD NS PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11312 $295.47CC WCB FAMILY MED CLINIC 97510066 HC PR 11400 EXC TR-EXT B9+MARG 0.5 < CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11400 $275.71CC WCB FAMILY MED CLINIC 97510068 HC PR 11402 EXC TR-EXT B9+MARG 1.1-2 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11402 $462.98CC WCB FAMILY MED CLINIC 97510070 HC PR 11403 EXC SKIN BENIG 2.1-3CM TRUNK, ARM, LEG PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11403 $593.03CC WCB FAMILY MED CLINIC 97510074 HC PR 11420 EXC H-F-NK-SP B9+MARG 0.5 < PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11420 $304.84CC WCB FAMILY MED CLINIC 97510075 HC PR 11422 EXC H-F-NK-SP B9+MARG 1.1-2 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11422 $492.11CC WCB FAMILY MED CLINIC 97510076 HC PR 11423 EXC H-F-NK-SP B9+MARG 2.1-3 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11423 $723.08CC WCB FAMILY MED CLINIC 97510077 HC PR 11426 EXC H-F-NK-SP B9+MARG > 4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11426 $1,272.41CC WCB FAMILY MED CLINIC 97510078 HC PR 11440 EXC FACE-MM B9+MARG 0.5 < CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11440 $362.06CC WCB FAMILY MED CLINIC 97510079 HC PR 11442 EXC FACE-MM B9+MARG 1.1-2 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11442 $636.72CC WCB FAMILY MED CLINIC 97510080 HC PR 11443 EXC FACE-MM B9+MARG 2.1-3 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11443 $810.47CC WCB FAMILY MED CLINIC 97510081 HC PR 11444 EXC FACE-MM B9+MARG 3.1-4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11444 $1,256.80CC WCB FAMILY MED CLINIC 97510082 HC PR 11621 EXC H-F-NK-SP MLG+MARG 0.6-1 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11621 $603.43CC WCB FAMILY MED CLINIC 97510083 HC PR 11622 EXC H-F-NK-SP MLG+MARG 1.1-2 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11622 $719.96CC WCB FAMILY MED CLINIC 97510084 HC PR 11623 EXC H-F-NK-SP MLG+MARG 2.1-3 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11623 $882.26CC WCB FAMILY MED CLINIC 97510085 HC PR 11624 EXC H-F-NK-SP MLG+MARG 3.1-4 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11624 $1,082.02CC WCB FAMILY MED CLINIC 97510086 HC PR 11626 EXC H-F-NK-SP MLG+MAR > 4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11626 $1,393.10CC WCB FAMILY MED CLINIC 97510087 HC PR 11640 EXC FACE-MM MALIG+MARG 0.5 < PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11640 $557.65

CC WCB FAMILY MED CLINIC 97510088 HC PR 11641 EXC FACE-MM MALIG+MARG 0.6-1 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11641 $719.96CC WCB FAMILY MED CLINIC 97510089 HC PR 11642 EXC FACE-MM MALIG+MARG 1.1-2 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11642 $905.15CC WCB FAMILY MED CLINIC 97510090 HC PR 11643 EXC FACE-MM MALIG+MARG 2.1-3 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11643 $1,160.05CC WCB FAMILY MED CLINIC 97510091 HC PR 11644 EXC FACE-MM MALIG+MARG 3.1-4 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11644 $1,346.28CC WCB FAMILY MED CLINIC 97510200 HC PR 35226 REPAIR BLOOD VESSEL LESION, LOWER EXTREMITY PROCEDURE Surgical Procedure-Profee ACTIVE 0975 35226 $4,576.72CC WCB FAMILY MED CLINIC 97510220 HC PR 38500 BIOPSY/REMOVAL LYMPH NODES PROCEDURE Surgical Procedure-Profee ACTIVE 0975 38500 $1,413.90CC WCB FAMILY MED CLINIC 97510253 HC PR 42330 REMOVAL OF SALIVARY STONE PROCEDURE Surgical Procedure-Profee ACTIVE 0975 42330 $888.50CC WCB FAMILY MED CLINIC 97510333 HC PR 15852 DRESSING CHANGE NOT FOR BURN UNDER ANESTHEPROCEDURE Surgical Procedure-Profee ACTIVE 0975 15852 $158.14CC WCB FAMILY MED CLINIC 97510334 HC PR 17000 DESTRUCT PREMALG LESION FIRST LESION PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17000 $142.53CC WCB FAMILY MED CLINIC 97510335 HC PR 17003 DESTRUCT PREMALG LES 2-14 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17003 $49.94CC WCB FAMILY MED CLINIC 97510336 HC PR 17004 DESTROY PREMLG LESIONS 15+ PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17004 $608.63CC WCB FAMILY MED CLINIC 97510337 HC PR 17111 DESTRUCT LESION 15 OR MORE PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17111 $288.19CC WCB FAMILY MED CLINIC 97510346 HC PR 17280 DESTRUCTION OF SKIN LESIONS FC EAR EYLDS NS LIP PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17280 $383.52CC WCB FAMILY MED CLINIC 97510347 HC PR 17281 DESTRUCTION OF SKIN LESIONS F E EY N L MOU 0.6 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17281 $407.84CC WCB FAMILY MED CLINIC 97510348 HC PR 17282 DESTRUCTION OF SKIN LESIONS FACE M 1.1-2 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 17282 $553.49CC WCB FAMILY MED CLINIC 97510355 HC PR 19100 BX BREAST PERCUT W/O IMAGE PROCEDURE Surgical Procedure-Profee ACTIVE 0975 19100 $628.40CC WCB FAMILY MED CLINIC 97510383 HC PR 20612 ASPIRATE/INJ GANGLION CYST PROCEDURE Surgical Procedure-Profee ACTIVE 0975 20612 $166.46CC WCB FAMILY MED CLINIC 97510408 HC PR 21920 BIOPSY SOFT TISSUE OF BACK PROCEDURE Surgical Procedure-Profee ACTIVE 0975 21920 $406.80CC WCB FAMILY MED CLINIC 97510428 HC PR 22900 EXC BACK TUM DEEP < 5 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 22900 $1,798.85CC WCB FAMILY MED CLINIC 97510436 HC PR 23076 EXC SHOULDER TUM DEEP < 5 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 23076 $2,102.65CC WCB FAMILY MED CLINIC 97510457 HC PR 11604 EXC TR-EXT MLG+MARG 3.1-4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11604 $859.37CC WCB FAMILY MED CLINIC 97510627 HC PR 27040 BX SOFT TISSUES,PELV/HIP,SUPERFICL PROCEDURE Surgical Procedure-Profee ACTIVE 0975 27040 $478.58CC WCB FAMILY MED CLINIC 97510647 HC PR 29131 APPLY FINGER SPLINT,DYNAMIC PROCEDURE Surgical Procedure-Profee ACTIVE 0975 29131 $268.42CC WCB FAMILY MED CLINIC 97510650 HC PR 41110 EXCIS TONGUE LESN PROCEDURE Surgical Procedure-Profee ACTIVE 0975 41110 $477.54CC WCB FAMILY MED CLINIC 97510667 HC PR 64455 INJECT PLANTAR COMMON DIGITAL NERVE PROCEDURE Surgical Procedure-Profee ACTIVE 0975 64455 $470.26CC WCB FAMILY MED CLINIC 97510678 HC PR 94760 NONINVASV OXYGEN SATUR;SINGLE PROCEDURE Surgical Procedure-Profee ACTIVE 0975 94760 $45.78CC WCB FAMILY MED CLINIC 97510758 HC PR 45330 DIAGNOSTIC SIGMOIDOSCOPY PROCEDURE ENDO-Profees ACTIVE 0975 45330 $460.90CC WCB FAMILY MED CLINIC 97510759 HC PR 45331 SIGMOIDOSCOPY AND BIOPSY PROCEDURE ENDO-Profees ACTIVE 0975 45331 $668.98CC WCB FAMILY MED CLINIC 97510760 HC PR 45332 SIGMOIDOSCOPY W/FB REMOVAL PROCEDURE ENDO-Profees ACTIVE 0975 45332 $836.48CC WCB FAMILY MED CLINIC 97510763 HC PR 45334 SIGMOIDOSCOPY FOR BLEEDING PROCEDURE ENDO-Profees ACTIVE 0975 45334 $1,254.72CC WCB FAMILY MED CLINIC 97510765 HC PR 45338 SIGMOIDOSCOPY W/TUMOR REMOVAL PROCEDURE ENDO-Profees ACTIVE 0975 45338 $1,449.28CC WCB FAMILY MED CLINIC 97510766 HC PR 45378 DIAGNOSTIC COLONOSCOPY PROCEDURE ENDO-Profees ACTIVE 0975 45378 $1,524.19CC WCB FAMILY MED CLINIC 97510768 HC PR 45380 COLONOSCOPY AND BIOPSY PROCEDURE ENDO-Profees ACTIVE 0975 45380 $1,676.08CC WCB FAMILY MED CLINIC 97510787 HC PR 46250 REMOVE EXT HEM GROUPS 2+ PROCEDURE Surgical Procedure-Profee ACTIVE 0975 46250 $1,718.74CC WCB FAMILY MED CLINIC 97510806 HC PR 46945 REMOVE BY LIGATION INTERNAL HEMORROID COLUPROCEDURE Surgical Procedure-Profee ACTIVE 0975 46945 $554.53CC WCB FAMILY MED CLINIC 97510910 HC PR 25111 REMOVE WRST TEND LESION PROCEDURE Surgical Procedure-Profee ACTIVE 0975 25111 $1,713.54CC WCB FAMILY MED CLINIC 97510936 HC PR 25112 REMOVE WRIST TENDON LESION - 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FAMILY MED CLINIC 98110025 HC PR 0131C SANE EXAM 15-45 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0131C $499.90CC WCB FAMILY MED CLINIC 98110025 HC PR 0131C SANE EXAM 15-45 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0131C $553.49CC WCB FAMILY MED CLINIC 98110026 HC PR 0132C SANE EXAM 49-119 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0132C $692.48CC WCB FAMILY MED CLINIC 98110026 HC PR 0132C SANE EXAM 49-119 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 0132C $894.74CC WCB FAMILY MED CLINIC 98110101 HC PR 92953 TEMP TRANSCUTANEOUS EXT PACING PROCEDURE ER MAIN-Profees ACTIVE 0981 92953 $190.18CC WCB FAMILY MED CLINIC 98110101 HC PR 92953 TEMP TRANSCUTANEOUS EXT PACING PROCEDURE ER MAIN-Profees ACTIVE 0981 92953 $220.56CC WCB FAMILY MED CLINIC 98110102 HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL PROCEDURE ER MAIN-Profees ACTIVE 0981 92960 $569.93CC WCB FAMILY MED CLINIC 98110102 HC PR 92960 CARDIOVERSION ELECTIVE EXTERNAL PROCEDURE ER MAIN-Profees ACTIVE 0981 92960 $574.30CC WCB FAMILY MED CLINIC 98110106 HC PR 26607 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BOPROCEDURE ER MAIN-Profees ACTIVE 0981 26607 $94.76CC WCB FAMILY MED CLINIC 98110106 HC PR 26607 CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BOPROCEDURE ER MAIN-Profees ACTIVE 0981 26607 $2,430.37CC WCB FAMILY MED CLINIC 98110146 HC PR 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99153 $66.30CC WCB FAMILY MED CLINIC 98110146 HC PR 99153 MOD SED SAME PHYS/QHP EA ADDL 15 MIN PROCEDURE ER MAIN-Profees ACTIVE 0981 99153 $102.00CC WCB FAMILY MED CLINIC 98110229 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10060 $250.61CC WCB FAMILY MED CLINIC 98110229 HC PR 10060 DRAINAGE OF SKIN ABSCESS SIMPLE OR SINGLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10060 $285.07CC WCB FAMILY MED CLINIC 98110231 HC PR 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MUL PROCEDURE ER MAIN-Profees ACTIVE 0981 10061 $556.41CC WCB FAMILY MED CLINIC 98110231 HC PR 10061 DRAINAGE OF SKIN ABSCESS COMPLICATED OR MUL PROCEDURE ER MAIN-Profees ACTIVE 0981 10061 $631.52CC WCB FAMILY MED CLINIC 98110232 HC PR 10080 DRAINAGE OF PILONIDAL CYST SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10080 $417.18CC WCB FAMILY MED CLINIC 98110232 HC PR 10080 DRAINAGE OF PILONIDAL CYST SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10080 $484.83CC WCB FAMILY MED CLINIC 98110234 HC PR 10120 REMOVE FOREIGN BODY SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10120 $278.21CC WCB FAMILY MED CLINIC 98110234 HC PR 10120 REMOVE FOREIGN BODY SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 10120 $386.51CC WCB FAMILY MED CLINIC 98110235 HC PR 10121 REMOVE FOREIGN BODY COMPLICATED PROCEDURE ER MAIN-Profees ACTIVE 0981 10121 $635.72CC WCB FAMILY MED CLINIC 98110235 HC PR 10121 REMOVE FOREIGN BODY COMPLICATED PROCEDURE ER MAIN-Profees ACTIVE 0981 10121 $707.47CC WCB FAMILY MED CLINIC 98110236 HC PR 10140 DRAINAGE OF HEMATOMA/FLUID PROCEDURE ER MAIN-Profees ACTIVE 0981 10140 $595.94CC WCB FAMILY 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REPAIR N-HF/GENIT UP TO 2.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12041 $501.53CC WCB FAMILY MED CLINIC 98110280 HC PR 12041 INTMD WND REPAIR N-HF/GENIT UP TO 2.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12041 $582.62CC WCB FAMILY MED CLINIC 98110281 HC PR 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12042 $541.82CC WCB FAMILY MED CLINIC 98110281 HC PR 12042 INTMD WND REPAIR N-HG/GENIT 2.6 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12042 $629.44CC WCB FAMILY MED CLINIC 98110282 HC PR 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12044 $704.41CC WCB FAMILY MED CLINIC 98110282 HC PR 12044 INTMD WND REPAIR N-HG/GENIT 7.6 TO 12.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12044 $817.75CC WCB FAMILY MED CLINIC 98110287 HC PR 12051 INTMD WND REPAIR FACE/MM <2.5 CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12051 $609.71CC WCB FAMILY MED CLINIC 98110287 HC PR 12051 INTMD WND REPAIR FACE/MM <2.5 CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12051 $707.47CC WCB FAMILY MED CLINIC 98110288 HC PR 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12052 $677.33CC WCB FAMILY MED CLINIC 98110288 HC PR 12052 INTMD WND REPAIR FACE/MM 2.6 TO 5.0CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12052 $786.54CC WCB FAMILY MED CLINIC 98110289 HC PR 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12053 $894.03CC WCB FAMILY MED CLINIC 98110289 HC PR 12053 INTMD WND REPAIR FACE/MM 5.1 TO 7.5CM PROCEDURE ER MAIN-Profees ACTIVE 0981 12053 $1,038.32CC WCB FAMILY MED CLINIC 98110295 HC PR 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13101 $799.88CC WCB FAMILY MED CLINIC 98110295 HC PR 13101 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13101 $854.17CC WCB FAMILY MED CLINIC 98110296 HC PR 13102 REPAIR WOUND/LESION ADD-ON EA ADD 5CM COM PROCEDURE ER MAIN-Profees ACTIVE 0981 13102 $339.17CC WCB FAMILY MED CLINIC 98110297 HC PR 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13120 $705.99CC WCB FAMILY MED CLINIC 98110297 HC PR 13120 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13120 $753.25CC WCB FAMILY MED CLINIC 98110298 HC PR 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13121 $1,082.32CC WCB FAMILY MED CLINIC 98110298 HC PR 13121 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM COMP PROCEDURE ER MAIN-Profees ACTIVE 0981 13121 $1,155.88CC WCB FAMILY MED CLINIC 98110299 HC PR 13122 REPAIR WOUND/LESION ADD-ON 5CM OR LESS COM PROCEDURE ER MAIN-Profees ACTIVE 0981 13122 $435.49CC WCB FAMILY MED CLINIC 98110299 HC PR 13122 REPAIR WOUND/LESION ADD-ON 5CM OR LESS COM PROCEDURE ER MAIN-Profees ACTIVE 0981 13122 $585.75CC WCB FAMILY MED CLINIC 98110304 HC PR 1040M ACCIDENT REPORT PROCEDURE ER MAIN-Profees ACTIVE 0981 1040M $112.71CC WCB FAMILY MED CLINIC 98110304 HC PR 1040M ACCIDENT REPORT PROCEDURE ER MAIN-Profees ACTIVE 0981 1040M $108.20CC WCB FAMILY MED CLINIC 98110307 HC PR 99080 SPECIAL REPORTS OR FORMS PROCEDURE ER MAIN-Profees ACTIVE 0981 99080 $59.30CC WCB FAMILY MED CLINIC 98110316 HC PR 30300 REMOVE NASAL FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 30300 $247.45CC WCB FAMILY MED CLINIC 98110316 HC PR 30300 REMOVE NASAL FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 30300 $256.98CC WCB FAMILY MED CLINIC 98110317 HC PR 30901 CONTROL OF NOSEBLEED SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 30901 $286.72

CC WCB FAMILY MED CLINIC 98110317 HC PR 30901 CONTROL OF NOSEBLEED SIMPLE PROCEDURE ER MAIN-Profees ACTIVE 0981 30901 $328.77CC WCB FAMILY MED CLINIC 98110319 HC PR 30903 CONTROL OF NOSEBLEED COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 30903 $424.07CC WCB FAMILY MED CLINIC 98110319 HC PR 30903 CONTROL OF NOSEBLEED COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 30903 $485.87CC WCB FAMILY MED CLINIC 98110321 HC PR 30905 CONTROL OF NOSEBLEED POSTERIOR PROCEDURE ER MAIN-Profees ACTIVE 0981 30905 $767.75CC WCB FAMILY MED CLINIC 98110321 HC PR 30905 CONTROL OF NOSEBLEED POSTERIOR PROCEDURE ER MAIN-Profees ACTIVE 0981 30905 $879.14CC WCB FAMILY MED CLINIC 98110324 HC PR 31500 INS EMERGENCY AIRWAY PROCEDURE ER MAIN-Profees ACTIVE 0981 31500 $537.03CC WCB FAMILY MED CLINIC 98110324 HC PR 31500 INS EMERGENCY AIRWAY PROCEDURE ER MAIN-Profees ACTIVE 0981 31500 $633.60CC WCB FAMILY MED CLINIC 98110342 HC PR 32551 INSERTION OF CHEST TUBE PROCEDURE ER MAIN-Profees ACTIVE 0981 32551 $796.16CC WCB FAMILY MED CLINIC 98110342 HC PR 32551 INSERTION OF CHEST TUBE PROCEDURE ER MAIN-Profees ACTIVE 0981 32551 $858.33CC WCB FAMILY MED CLINIC 98110375 HC PR 43753 TX GASTRO INTUB W/ASP PROCEDURE ER MAIN-Profees ACTIVE 0981 43753 $403.41CC WCB FAMILY MED CLINIC 98110375 HC PR 43753 TX GASTRO INTUB W/ASP PROCEDURE ER MAIN-Profees ACTIVE 0981 43753 $402.63CC WCB FAMILY MED CLINIC 98110381 HC PR 46040 INCISION OF RECTAL ABSCESS PROCEDURE ER MAIN-Profees ACTIVE 0981 46040 $1,362.92CC WCB FAMILY MED CLINIC 98110383 HC PR 46083 INCISE EXTERNAL HEMORRHOID PROCEDURE ER MAIN-Profees ACTIVE 0981 46083 $402.59CC WCB FAMILY MED CLINIC 98110383 HC PR 46083 INCISE EXTERNAL HEMORRHOID PROCEDURE ER MAIN-Profees ACTIVE 0981 46083 $410.96CC WCB FAMILY MED CLINIC 98110386 HC PR 46320 REMOVAL OF HEMORRHOID CLOT PROCEDURE ER MAIN-Profees ACTIVE 0981 46320 $491.07CC WCB FAMILY MED CLINIC 98110387 HC PR 46600 DIAGNOSTIC ANOSCOPY PROCEDURE ER MAIN-Profees ACTIVE 0981 46600 $281.11CC WCB FAMILY MED CLINIC 98110387 HC PR 46600 DIAGNOSTIC ANOSCOPY PROCEDURE ER MAIN-Profees ACTIVE 0981 46600 $225.77CC WCB FAMILY MED CLINIC 98110395 HC PR 51700 IRRIGATION OF BLADDER PROCEDURE ER MAIN-Profees ACTIVE 0981 51700 $275.71CC WCB FAMILY MED CLINIC 98110396 HC PR 51702 INSERT TEMP BLADDER CATHETER PROCEDURE ER MAIN-Profees ACTIVE 0981 51702 $239.24CC WCB FAMILY MED CLINIC 98110396 HC PR 51702 INSERT TEMP BLADDER CATHETER PROCEDURE ER MAIN-Profees ACTIVE 0981 51702 $262.18CC WCB FAMILY MED CLINIC 98110397 HC PR 51703 INSERT BLADDER CATHETER COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 51703 $440.23CC WCB FAMILY MED CLINIC 98110397 HC PR 51703 INSERT BLADDER CATHETER COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 51703 $481.71CC WCB FAMILY MED CLINIC 98110402 HC PR 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MA PROCEDURE ER MAIN-Profees ACTIVE 0981 27786 $941.46CC WCB FAMILY MED CLINIC 98110402 HC PR 27786 CLOSED TREATMENT OF ANKLE FRACTURE W/O MA PROCEDURE ER MAIN-Profees ACTIVE 0981 27786 $1,090.34CC WCB FAMILY MED CLINIC 98110406 HC PR 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MAN PROCEDURE ER MAIN-Profees ACTIVE 0981 27808 $1,088.65CC WCB FAMILY MED CLINIC 98110406 HC PR 27808 TREATMENT OF ANKLE FRACTURE BIMAL W/O MAN PROCEDURE ER MAIN-Profees ACTIVE 0981 27808 $1,503.38CC WCB FAMILY MED CLINIC 98110410 HC PR 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATIONPROCEDURE ER MAIN-Profees ACTIVE 0981 27816 $1,206.15CC WCB FAMILY MED CLINIC 98110410 HC PR 27816 CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATIONPROCEDURE ER MAIN-Profees ACTIVE 0981 27816 $1,397.26CC WCB FAMILY MED CLINIC 98110414 HC PR 27824 CLOSED TREAT LOWER LEG FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27824 $1,139.34CC WCB FAMILY MED CLINIC 98110414 HC PR 27824 CLOSED TREAT LOWER LEG FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27824 $1,397.26CC WCB FAMILY MED CLINIC 98110429 HC PR 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28430 $914.43CC WCB FAMILY MED CLINIC 98110429 HC PR 28430 TREATMENT OF TALUS FRACTURE W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28430 $1,119.47CC WCB FAMILY MED CLINIC 98110432 HC PR 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28450 $792.69CC WCB FAMILY MED CLINIC 98110432 HC PR 28450 TREAT MIDFOOT FRACTURE EACH W/O MANIPULAT PROCEDURE ER MAIN-Profees ACTIVE 0981 28450 $1,042.48CC WCB FAMILY MED CLINIC 98110436 HC PR 28470 TREAT METATARSAL FRACTURE W/O MANIPULATIO PROCEDURE ER MAIN-Profees ACTIVE 0981 28470 $729.61CC WCB FAMILY MED CLINIC 98110436 HC PR 28470 TREAT METATARSAL FRACTURE W/O MANIPULATIO PROCEDURE ER MAIN-Profees ACTIVE 0981 28470 $827.12CC WCB FAMILY MED CLINIC 98110440 HC PR 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28490 $410.55CC WCB FAMILY MED CLINIC 98110440 HC PR 28490 CLOSED TREAT BIG TOE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28490 $542.05CC WCB FAMILY MED CLINIC 98110445 HC PR 28510 TREATMENT OF TOE FRACTURE PHALANX PROCEDURE ER MAIN-Profees ACTIVE 0981 28510 $334.46CC WCB FAMILY MED CLINIC 98110445 HC PR 28510 TREATMENT OF TOE FRACTURE PHALANX PROCEDURE ER MAIN-Profees ACTIVE 0981 28510 $423.44CC WCB FAMILY MED CLINIC 98110448 HC PR 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28515 $501.79CC WCB FAMILY MED CLINIC 98110448 HC PR 28515 TREATMENT OF TOE FRACTURE PHALANX W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 28515 $568.06CC WCB FAMILY MED CLINIC 98110460 HC PR 28630 TREAT METATARSOPHAL DISLOCATION PROCEDURE ER MAIN-Profees ACTIVE 0981 28630 $637.77CC WCB FAMILY MED CLINIC 98110462 HC PR 28660 CLOSED TREAT TOE DISLOCATION PROCEDURE ER MAIN-Profees ACTIVE 0981 28660 $481.71CC WCB FAMILY MED CLINIC 98110466 HC PR 29065 LONG ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29065 $314.57CC WCB FAMILY MED CLINIC 98110466 HC PR 29065 LONG ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29065 $352.70CC WCB FAMILY MED CLINIC 98110467 HC PR 29075 SHORT ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29075 $243.22CC WCB FAMILY MED CLINIC 98110467 HC PR 29075 SHORT ARM CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29075 $272.58CC WCB FAMILY MED CLINIC 98110468 HC PR 29105 LONG ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29105 $198.39CC WCB FAMILY MED CLINIC 98110468 HC PR 29105 LONG ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29105 $224.73CC WCB FAMILY MED CLINIC 98110469 HC PR 29125 SHORT ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29125 $171.62CC WCB FAMILY MED CLINIC 98110469 HC PR 29125 SHORT ARM SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29125 $264.26CC WCB FAMILY MED CLINIC 98110471 HC PR 29200 STRAPPING OF CHEST DYN PROCEDURE ER MAIN-Profees ACTIVE 0981 29200 $129.01CC WCB FAMILY MED CLINIC 98110472 HC PR 29240 STRAPPING SHOULDER PROCEDURE ER MAIN-Profees ACTIVE 0981 29240 $112.36CC WCB FAMILY MED CLINIC 98110473 HC PR 29260 STRAPPING OF ELBOW OR WRIST PROCEDURE ER MAIN-Profees ACTIVE 0981 29260 $100.27

CC WCB FAMILY MED CLINIC 98110473 HC PR 29260 STRAPPING OF ELBOW OR WRIST PROCEDURE ER MAIN-Profees ACTIVE 0981 29260 $112.36CC WCB FAMILY MED CLINIC 98110476 HC PR 29405 SHORT LEG CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29405 $343.18CC WCB FAMILY MED CLINIC 98110476 HC PR 29405 SHORT LEG CAST APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29405 $384.95CC WCB FAMILY MED CLINIC 98110479 HC PR 29505 APPLICATION LONG LEG SPLINT PROCEDURE ER MAIN-Profees ACTIVE 0981 29505 $286.16CC WCB FAMILY MED CLINIC 98110479 HC PR 29505 APPLICATION LONG LEG SPLINT PROCEDURE ER MAIN-Profees ACTIVE 0981 29505 $321.48CC WCB FAMILY MED CLINIC 98110480 HC PR 29515 SHORT LEG SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29515 $185.95CC WCB FAMILY MED CLINIC 98110480 HC PR 29515 SHORT LEG SPLINT APPLICATION PROCEDURE ER MAIN-Profees ACTIVE 0981 29515 $209.12CC WCB FAMILY MED CLINIC 98110481 HC PR 29540 STRAPPING OF ANKLE AND/OR FT PROCEDURE ER MAIN-Profees ACTIVE 0981 29540 $129.01CC WCB FAMILY MED CLINIC 98110482 HC PR 29580 APPLICATION OF UNABOOT PROCEDURE ER MAIN-Profees ACTIVE 0981 29580 $160.19CC WCB FAMILY MED CLINIC 98110482 HC PR 29580 APPLICATION OF UNABOOT PROCEDURE ER MAIN-Profees ACTIVE 0981 29580 $179.99CC WCB FAMILY MED CLINIC 98110485 HC PR 28190 REMOVAL OF FOOT FOREIGN BODY PROCEDURE ER MAIN-Profees ACTIVE 0981 28190 $760.53CC WCB FAMILY MED CLINIC 98110486 HC PR 29345 APPLICATION/LONG LEG CAST PROCEDURE ER MAIN-Profees ACTIVE 0981 29345 $414.53CC WCB FAMILY MED CLINIC 98110486 HC PR 29345 APPLICATION/LONG LEG CAST PROCEDURE ER MAIN-Profees ACTIVE 0981 29345 $465.06CC WCB FAMILY MED CLINIC 98110489 HC PR 99282 EMERGENCY DEPT VISIT LEVEL II PROCEDURE ER MAIN-Profees ACTIVE 0981 99282 $199.72CC WCB FAMILY MED CLINIC 98110489 HC PR 99282 EMERGENCY DEPT VISIT LEVEL II PROCEDURE ER MAIN-Profees ACTIVE 0981 99282 $244.49CC WCB FAMILY MED CLINIC 98110501 HC PR 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13131 $823.45CC WCB FAMILY MED CLINIC 98110501 HC PR 13131 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13131 $879.14CC WCB FAMILY MED CLINIC 98110502 HC PR 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13132 $1,599.46CC WCB FAMILY MED CLINIC 98110502 HC PR 13132 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13132 $1,708.34CC WCB FAMILY MED CLINIC 98110503 HC PR 13133 REPAIR WOUND/LESION ADD-ON 5CM CMPLX, FRHD PROCEDURE ER MAIN-Profees ACTIVE 0981 13133 $635.15CC WCB FAMILY MED CLINIC 98110503 HC PR 13133 REPAIR WOUND/LESION ADD-ON 5CM CMPLX, FRHD PROCEDURE ER MAIN-Profees ACTIVE 0981 13133 $780.30CC WCB FAMILY MED CLINIC 98110505 HC PR 13151 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13151 $1,035.10CC WCB FAMILY MED CLINIC 98110505 HC PR 13151 REPAIR OF WOUND OR LESION 1.1 TO 2.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13151 $1,104.90CC WCB FAMILY MED CLINIC 98110506 HC PR 13152 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13152 $2,022.97CC WCB FAMILY MED CLINIC 98110506 HC PR 13152 REPAIR OF WOUND OR LESION 2.6 TO 7.5CM CMPLX PROCEDURE ER MAIN-Profees ACTIVE 0981 13152 $2,159.87CC WCB FAMILY MED CLINIC 98110509 HC PR 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX PROCEDURE ER MAIN-Profees ACTIVE 0981 16000 $141.88CC WCB FAMILY MED CLINIC 98110509 HC PR 16000 INITIAL TREATMENT OF BURN(S) 1ST DEG LOCAL TX PROCEDURE ER MAIN-Profees ACTIVE 0981 16000 $158.14CC WCB FAMILY MED CLINIC 98110510 HC PR 16020 DRESS/DEBRID P-THICK BURN S <5% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16020 $219.10CC WCB FAMILY MED CLINIC 98110510 HC PR 16020 DRESS/DEBRID P-THICK BURN S <5% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16020 $243.45CC WCB FAMILY MED CLINIC 98110511 HC PR 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16025 $347.72CC WCB FAMILY MED CLINIC 98110511 HC PR 16025 DRESS/DEBRID P-THICK BURN M 5-10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16025 $387.03CC WCB FAMILY MED CLINIC 98110512 HC PR 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16030 $515.05CC WCB FAMILY MED CLINIC 98110512 HC PR 16030 DRESS/DEBRID P-THICK BURN L >10% TBSA PROCEDURE ER MAIN-Profees ACTIVE 0981 16030 $573.26CC WCB FAMILY MED CLINIC 98110514 HC PR 19000 DRAINAGE OF BREAST LESION PROCEDURE ER MAIN-Profees ACTIVE 0981 19000 $362.06CC WCB FAMILY MED CLINIC 98110520 HC PR 20103 EXPLORE WOUND EXTREMITY PROCEDURE ER MAIN-Profees ACTIVE 0981 20103 $2,174.39CC WCB FAMILY MED CLINIC 98110520 HC PR 20103 EXPLORE WOUND EXTREMITY PROCEDURE ER MAIN-Profees ACTIVE 0981 20103 $197.68CC WCB FAMILY MED CLINIC 98110521 HC PR 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP PROCEDURE ER MAIN-Profees ACTIVE 0981 20520 $422.99CC WCB FAMILY MED CLINIC 98110521 HC PR 20520 REMOVAL OF FOREIGN BODY MUSC, SIMP PROCEDURE ER MAIN-Profees ACTIVE 0981 20520 $485.87CC WCB FAMILY MED CLINIC 98110522 HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 20525 $1,063.20CC WCB FAMILY MED CLINIC 98110522 HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX PROCEDURE ER MAIN-Profees ACTIVE 0981 20525 $1,220.39CC WCB FAMILY MED CLINIC 98110523 HC PR 20550 INJ TENDON SHEATH/LIGAMENT PROCEDURE ER MAIN-Profees ACTIVE 0981 20550 $236.17CC WCB FAMILY MED CLINIC 98110524 HC PR 20551 INJ TENDON ORIGIN/INSERTION PROCEDURE ER MAIN-Profees ACTIVE 0981 20551 $236.17CC WCB FAMILY MED CLINIC 98110525 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL PROCEDURE ER MAIN-Profees ACTIVE 0981 20552 $195.74CC WCB FAMILY MED CLINIC 98110525 HC PR 20552 INJ TRIGGER POINT 1/2 MUSCL PROCEDURE ER MAIN-Profees ACTIVE 0981 20552 $250.74CC WCB FAMILY MED CLINIC 98110526 HC PR 20553 INJECT TRIGGER POINTS =/> 3 PROCEDURE ER MAIN-Profees ACTIVE 0981 20553 $202.88CC WCB FAMILY MED CLINIC 98110528 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOU PROCEDURE ER MAIN-Profees ACTIVE 0981 20600 $264.69CC WCB FAMILY MED CLINIC 98110528 HC PR 20600 DRAIN/INJECT JOINT/BURSA SMALL W/O ULTRASOU PROCEDURE ER MAIN-Profees ACTIVE 0981 20600 $222.65CC WCB FAMILY MED CLINIC 98110529 HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASO PROCEDURE ER MAIN-Profees ACTIVE 0981 20605 $205.53CC WCB FAMILY MED CLINIC 98110529 HC PR 20605 DRAIN/INJECT JOINT/BURSA INTERM W/O ULTRASO PROCEDURE ER MAIN-Profees ACTIVE 0981 20605 $236.17CC WCB FAMILY MED CLINIC 98110531 HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR PROCEDURE ER MAIN-Profees ACTIVE 0981 20610 $229.96CC WCB FAMILY MED CLINIC 98110531 HC PR 20610 DRAIN/INJECT JOINT/BURSA MAJOR PROCEDURE ER MAIN-Profees ACTIVE 0981 20610 $264.26CC WCB FAMILY MED CLINIC 98110533 HC PR 21310 TREATMENT OF NOSE FRACTURE W/O MANIPULATI PROCEDURE ER MAIN-Profees ACTIVE 0981 21310 $452.17CC WCB FAMILY MED CLINIC 98110533 HC PR 21310 TREATMENT OF NOSE FRACTURE W/O MANIPULATI PROCEDURE ER MAIN-Profees ACTIVE 0981 21310 $572.22CC WCB FAMILY MED CLINIC 98110549 HC PR 23031 DRAIN SHOULDER BURSA PROCEDURE ER MAIN-Profees ACTIVE 0981 23031 $1,237.04CC WCB FAMILY MED CLINIC 98110551 HC PR 23500 TREAT CLAVICLE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23500 $659.02

CC WCB FAMILY MED CLINIC 98110551 HC PR 23500 TREAT CLAVICLE FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23500 $767.82CC WCB FAMILY MED CLINIC 98110561 HC PR 23570 TREAT SHOULDER BLADE FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23570 $784.23CC WCB FAMILY MED CLINIC 98110561 HC PR 23570 TREAT SHOULDER BLADE FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23570 $914.51CC WCB FAMILY MED CLINIC 98110563 HC PR 23600 TREAT HUMERUS FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23600 $1,003.78CC WCB FAMILY MED CLINIC 98110563 HC PR 23600 TREAT HUMERUS FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23600 $1,169.41CC WCB FAMILY MED CLINIC 98110570 HC PR 23650 TREAT SHOULDER DISLOCATION W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23650 $878.37CC WCB FAMILY MED CLINIC 98110570 HC PR 23650 TREAT SHOULDER DISLOCATION W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 23650 $1,023.75CC WCB FAMILY MED CLINIC 98110572 HC PR 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNESPROCEDURE ER MAIN-Profees ACTIVE 0981 23655 $1,317.53CC WCB FAMILY MED CLINIC 98110572 HC PR 23655 TREAT SHOULDER DISLOCATION W/MANIP & ANNESPROCEDURE ER MAIN-Profees ACTIVE 0981 23655 $1,535.63CC WCB FAMILY MED CLINIC 98110578 HC PR 23931 DRAINAGE OF ARM BURSA PROCEDURE ER MAIN-Profees ACTIVE 0981 23931 $1,323.39CC WCB FAMILY MED CLINIC 98110596 HC PR 92950 CARDIOPULMONARY RESUSCITATION PROCEDURE ER MAIN-Profees ACTIVE 0981 92950 $683.96CC WCB FAMILY MED CLINIC 98110596 HC PR 92950 CARDIOPULMONARY RESUSCITATION PROCEDURE ER MAIN-Profees ACTIVE 0981 92950 $792.78CC WCB FAMILY MED CLINIC 98110597 HC PR 94150 VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE) PROCEDURE ER MAIN-Profees ACTIVE 0981 94150 $98.84CC WCB FAMILY MED CLINIC 98110603 HC PR 59414 DELIVER PLACENTA PROCEDURE ER MAIN-Profees ACTIVE 0981 59414 $828.75CC WCB FAMILY MED CLINIC 98110603 HC PR 59414 DELIVER PLACENTA PROCEDURE ER MAIN-Profees ACTIVE 0981 59414 $889.54CC WCB FAMILY MED CLINIC 98110604 HC PR 99281 EMERGENCY DEPT VISIT LEVEL I PROCEDURE ER MAIN-Profees ACTIVE 0981 99281 $148.51CC WCB FAMILY MED CLINIC 98110604 HC PR 99281 EMERGENCY DEPT VISIT LEVEL I PROCEDURE ER MAIN-Profees ACTIVE 0981 99281 $182.07CC WCB FAMILY MED CLINIC 98110605 HC PR 93005 ECG 12 LEAD TRACING ONLY PROCEDURE ER MAIN-Profees ACTIVE 0981 93005 $73.44CC WCB FAMILY MED CLINIC 98110621 HC PR 25248 REMOVE FOREARM FOREIGN BODY -FOREARM WRS PROCEDURE ER MAIN-Profees ACTIVE 0981 25248 $1,586.61CC WCB FAMILY MED CLINIC 98110625 HC PR 29550 STRAPPING OF TOES PROCEDURE ER MAIN-Profees ACTIVE 0981 29550 $81.15CC WCB FAMILY MED CLINIC 98110626 HC PR 29530 STRAPPING OF KNEE PROCEDURE ER MAIN-Profees ACTIVE 0981 29530 $136.29CC WCB FAMILY MED CLINIC 98110701 HC PR 24500 TREAT HUMERUS FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 24500 $1,030.05CC WCB FAMILY MED CLINIC 98110701 HC PR 24500 TREAT HUMERUS FX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 24500 $1,187.10CC WCB FAMILY MED CLINIC 98110707 HC PR 24560 TREAT HUMERUS EPICOND FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24560 $1,100.58CC WCB FAMILY MED CLINIC 98110707 HC PR 24560 TREAT HUMERUS EPICOND FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24560 $1,298.42CC WCB FAMILY MED CLINIC 98110713 HC PR 24600 TREAT ELBOW DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 24600 $1,033.52CC WCB FAMILY MED CLINIC 98110713 HC PR 24600 TREAT ELBOW DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 24600 $1,038.32CC WCB FAMILY MED CLINIC 98110716 HC PR 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 24640 $428.04CC WCB FAMILY MED CLINIC 98110716 HC PR 24640 CLOSED TREAT OF RADIAL HEAD SUBLUXATION W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 24640 $493.15CC WCB FAMILY MED CLINIC 98110718 HC PR 24650 TREAT RADIUS FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24650 $888.42CC WCB FAMILY MED CLINIC 98110718 HC PR 24650 TREAT RADIUS FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24650 $951.97CC WCB FAMILY MED CLINIC 98110722 HC PR 24670 TREAT ULNAR FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24670 $1,144.64CC WCB FAMILY MED CLINIC 98110722 HC PR 24670 TREAT ULNAR FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 24670 $1,142.36CC WCB FAMILY MED CLINIC 98110730 HC PR 25500 TREAT FRACTUE OF RADIUS W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0975 25500 $865.11CC WCB FAMILY MED CLINIC 98110730 HC PR 25500 TREAT FRACTUE OF RADIUS W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0975 25500 $1,046.64CC WCB FAMILY MED CLINIC 98110734 HC PR 25530 TREAT FRACTURE OF ULNA PROCEDURE ER MAIN-Profees ACTIVE 0981 25530 $875.47CC WCB FAMILY MED CLINIC 98110734 HC PR 25530 TREAT FRACTURE OF ULNA PROCEDURE ER MAIN-Profees ACTIVE 0981 25530 $928.04CC WCB FAMILY MED CLINIC 98110738 HC PR 25560 TREAT FRACTURE OF RADIUS AND ULNA W/O MANIPPROCEDURE ER MAIN-Profees ACTIVE 0981 25560 $927.18CC WCB FAMILY MED CLINIC 98110738 HC PR 25560 TREAT FRACTURE OF RADIUS AND ULNA W/O MANIPPROCEDURE ER MAIN-Profees ACTIVE 0981 25560 $1,076.81CC WCB FAMILY MED CLINIC 98110742 HC PR 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 25600 $978.33CC WCB FAMILY MED CLINIC 98110742 HC PR 25600 TREAT DISTAL RADIAL FRACTURE RADIUS/UNA W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 25600 $1,136.12CC WCB FAMILY MED CLINIC 98110744 HC PR 25605 TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 25605 $2,110.99CC WCB FAMILY MED CLINIC 98110744 HC PR 25605 TREAT DISTAL RADIAL FRACTURE RADIUS/ULNA W/MPROCEDURE ER MAIN-Profees ACTIVE 0981 25605 $2,185.88CC WCB FAMILY MED CLINIC 98110746 HC PR 25622 TREAT WRIST BONE FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25622 $1,030.05CC WCB FAMILY MED CLINIC 98110746 HC PR 25622 TREAT WRIST BONE FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25622 $1,196.46CC WCB FAMILY MED CLINIC 98110754 HC PR 25650 TREAT ULNAR STYLOID FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25650 $1,153.93CC WCB FAMILY MED CLINIC 98110754 HC PR 25650 TREAT ULNAR STYLOID FRACTURE PROCEDURE ER MAIN-Profees ACTIVE 0981 25650 $1,326.51CC WCB FAMILY MED CLINIC 98110761 HC PR 26010 DRAINAGE OF FINGER ABSCESS - SMPL PROCEDURE ER MAIN-Profees ACTIVE 0981 26010 $400.55CC WCB FAMILY MED CLINIC 98110771 HC PR 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26600 $798.81CC WCB FAMILY MED CLINIC 98110771 HC PR 26600 TREAT METACARPAL FRACTURE SINGLE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26600 $891.62CC WCB FAMILY MED CLINIC 98110773 HC PR 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26605 $1,198.19CC WCB FAMILY MED CLINIC 98110773 HC PR 26605 TREAT METACARPAL FRACTURE SINGLE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26605 $1,336.91CC WCB FAMILY MED CLINIC 98110781 HC PR 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26700 $751.59CC WCB FAMILY MED CLINIC 98110781 HC PR 26700 TREAT KNUCKLE DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26700 $1,120.51CC WCB FAMILY MED CLINIC 98110783 HC PR 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER O PROCEDURE ER MAIN-Profees ACTIVE 0981 26720 $544.73

CC WCB FAMILY MED CLINIC 98110783 HC PR 26720 CLOSED TX PHALANGEAL SHAFT FRACTURE FINGER O PROCEDURE ER MAIN-Profees ACTIVE 0981 26720 $608.63CC WCB FAMILY MED CLINIC 98110788 HC PR 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26740 $835.13CC WCB FAMILY MED CLINIC 98110788 HC PR 26740 CLOSED TX ARTICULAR FRACTURE W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 26740 $932.20CC WCB FAMILY MED CLINIC 98110792 HC PR 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FINGER/ PROCEDURE ER MAIN-Profees ACTIVE 0981 26750 $472.36CC WCB FAMILY MED CLINIC 98110792 HC PR 26750 CLOSED TX DISTAL PHALANGEAL FRACTURE FINGER/ PROCEDURE ER MAIN-Profees ACTIVE 0981 26750 $526.44CC WCB FAMILY MED CLINIC 98110795 HC PR 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/TH PROCEDURE ER MAIN-Profees ACTIVE 0981 26765 $2,033.32CC WCB FAMILY MED CLINIC 98110795 HC PR 26765 OPEN TX DISTAL PHALANGEAL FRACTURE FINGER/TH PROCEDURE ER MAIN-Profees ACTIVE 0981 26765 $2,269.11CC WCB FAMILY MED CLINIC 98110798 HC PR 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26770 $508.42CC WCB FAMILY MED CLINIC 98110798 HC PR 26770 CLOSED TX FINGER DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26770 $568.06CC WCB FAMILY MED CLINIC 98110800 HC PR 26775 CLOSED TX FINGER DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26775 $762.76CC WCB FAMILY MED CLINIC 98110800 HC PR 26775 CLOSED TX FINGER DISLOCATION W/ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 26775 $851.05CC WCB FAMILY MED CLINIC 98110808 HC PR 58301 REMOVE INTRAUTERINE DEVICE PROCEDURE ER MAIN-Profees ACTIVE 0981 58301 $174.01CC WCB FAMILY MED CLINIC 98110808 HC PR 58301 REMOVE INTRAUTERINE DEVICE PROCEDURE ER MAIN-Profees ACTIVE 0981 58301 $174.79CC WCB FAMILY MED CLINIC 98110812 HC PR 62270 SPINAL FLUID TAP DIAGNOSTIC PROCEDURE ER MAIN-Profees ACTIVE 0981 62270 $429.93CC WCB FAMILY MED CLINIC 98110812 HC PR 62270 SPINAL FLUID TAP DIAGNOSTIC PROCEDURE ER MAIN-Profees ACTIVE 0981 62270 $488.99CC WCB FAMILY MED CLINIC 98110813 HC PR 62272 DRAIN CEREBRO SPINAL FLUID PROCEDURE ER MAIN-Profees ACTIVE 0981 62272 $634.64CC WCB FAMILY MED CLINIC 98110818 HC PR 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL PROCEDURE ER MAIN-Profees ACTIVE 0981 65205 $238.99CC WCB FAMILY MED CLINIC 98110818 HC PR 65205 REMOVE FOREIGN BODY FROM EYE SUPERFICIAL PROCEDURE ER MAIN-Profees ACTIVE 0981 65205 $243.45CC WCB FAMILY MED CLINIC 98110819 HC PR 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED PROCEDURE ER MAIN-Profees ACTIVE 0981 65210 $259.13CC WCB FAMILY MED CLINIC 98110819 HC PR 65210 REMOVE FOREIGN BODY FROM EYE EMBEDDED PROCEDURE ER MAIN-Profees ACTIVE 0981 65210 $264.26CC WCB FAMILY MED CLINIC 98110820 HC PR 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O S PROCEDURE ER MAIN-Profees ACTIVE 0981 65220 $279.02CC WCB FAMILY MED CLINIC 98110820 HC PR 65220 REMOVE FOREIGN BODY FROM EYE CORNEAL W/O S PROCEDURE ER MAIN-Profees ACTIVE 0981 65220 $284.03CC WCB 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PROCEDURE ER MAIN-Profees ACTIVE 0981 69210 $151.90CC WCB FAMILY MED CLINIC 98110873 HC PR 27520 CLOSED TREAT PATELLAR FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27520 $968.80CC WCB FAMILY MED CLINIC 98110873 HC PR 27520 CLOSED TREAT PATELLAR FRACTURE W/MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27520 $1,303.62CC WCB FAMILY MED CLINIC 98110876 HC PR 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 27530 $1,255.21CC WCB FAMILY MED CLINIC 98110876 HC PR 27530 CLTX TIBIAL FX PROXIMAL W/O MANIPULATION PROCEDURE ER MAIN-Profees ACTIVE 0981 27530 $1,730.19CC WCB FAMILY MED CLINIC 98110878 HC PR 27550 TREAT KNEE DISLOCATION PROCEDURE ER MAIN-Profees ACTIVE 0981 27550 $999.82CC WCB FAMILY MED CLINIC 98110881 HC PR 27560 CLOSED TREAT KNEE DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 27560 $682.38CC WCB FAMILY MED CLINIC 98110881 HC PR 27560 CLOSED TREAT KNEE DISLOCATION W/O ANESTH PROCEDURE ER MAIN-Profees ACTIVE 0981 27560 $781.34CC WCB FAMILY MED CLINIC 98110882 HC PR 27562 CLOSED TREAT PATELLA DISLOCATION W/ANSETH PROCEDURE ER MAIN-Profees ACTIVE 0981 27562 $1,078.60CC WCB FAMILY MED CLINIC 98110882 HC PR 27562 CLOSED TREAT PATELLA DISLOCATION W/ANSETH PROCEDURE ER MAIN-Profees ACTIVE 0981 27562 $1,171.49CC WCB FAMILY MED CLINIC 98110884 HC PR 27603 DRAIN LOWER LEG LESION DEEP PROCEDURE ER MAIN-Profees ACTIVE 0981 27603 $1,590.77CC WCB FAMILY MED CLINIC 98110892 HC PR 27760 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 27760 $1,085.74CC WCB FAMILY MED CLINIC 98110892 HC PR 27760 CLOSED TX OF MEDIAL MALLEOLUS FRACTURE W/O PROCEDURE ER MAIN-Profees ACTIVE 0981 27760 $1,258.88CC WCB FAMILY MED CLINIC 98110898 HC PR 27780 CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27780 $873.58CC WCB FAMILY MED CLINIC 98110898 HC PR 27780 CLOSED TX OF FIBULA FRACTURE PROX W/O MANIP PROCEDURE ER MAIN-Profees ACTIVE 0981 27780 $937.40CC WCB FAMILY MED CLINIC 98110906 HC PR 29130 APLICATION OF FINGER SPLINT STATIC PROCEDURE ER MAIN-Profees ACTIVE 0981 29130 $114.60CC WCB FAMILY MED CLINIC 98110906 HC PR 29130 APLICATION OF FINGER SPLINT STATIC PROCEDURE ER MAIN-Profees ACTIVE 0981 29130 $129.01CC WCB FAMILY MED CLINIC 98110907 HC PR 49082 ABD PARACENT W/O IMAG GUID PROCEDURE ER MAIN-Profees ACTIVE 0981 49082 $506.53CC WCB FAMILY MED CLINIC 98110907 HC PR 49082 ABD PARACENT W/O IMAG GUID PROCEDURE ER MAIN-Profees ACTIVE 0981 49082 $560.78CC WCB FAMILY MED CLINIC 98110910 HC PR 36416 CAPILLARY BLOOD DRAW PROCEDURE ER MAIN-Profees ACTIVE 0981 36416 $18.67CC WCB FAMILY MED CLINIC 98110914 HC PR 1073M ACTIVITY PRESCRIPTION FORM,INSURER REQ PROCEDURE ER MAIN-Profees ACTIVE 0981 1073M $96.29CC WCB FAMILY MED CLINIC 98110914 HC PR 1073M ACTIVITY PRESCRIPTION FORM,INSURER REQ PROCEDURE ER MAIN-Profees ACTIVE 0981 1073M $92.60CC WCB FAMILY MED CLINIC 98110931 HC PR 32554 THORACENTESIS/ASPIR W/O IMG GD PROCEDURE ER MAIN-Profees ACTIVE 0981 32554 $526.17CC WCB FAMILY MED CLINIC 98110931 HC PR 32554 THORACENTESIS/ASPIR W/O IMG GD PROCEDURE ER MAIN-Profees ACTIVE 0981 32554 $567.02CC WCB FAMILY MED CLINIC 98110941 HC PR 28635 TREAT TOE DISLOCATION W/MANIPULATION W/AN PROCEDURE ER MAIN-Profees ACTIVE 0981 28635 $805.44CC WCB FAMILY MED CLINIC 98110941 HC PR 28635 TREAT TOE DISLOCATION W/MANIPULATION W/AN PROCEDURE ER MAIN-Profees ACTIVE 0981 28635 $722.04

CC WCB FAMILY MED CLINIC 98210022 HC PR 97602 WOUND(S) CARE NON-SELECTIVE PROCEDURE PT/OT/ST-Profees ACTIVE 0982 97602 $96.76CC WCB FAMILY MED CLINIC 98210094 HC PR 1028M L&I ADDITIONAL JOB ANALYSIS PROCEDURE E & M-Profees ACTIVE 0982 1028M $34.33CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $152.95CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $152.95CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $81.50CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $20.00CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $101.50CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $101.50CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $0.00CC WCB FAMILY MED CLINIC 98310001 HC PR 99201 NEW PT VISIT - LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99201 $101.50CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $190.38CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $35.00CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $140.00CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $175.00CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $175.00CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $175.00CC WCB FAMILY MED CLINIC 98310002 HC PR 99202 NEW PT VISIT - LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99202 $0.00CC WCB FAMILY MED CLINIC 98310003 HC PR 99203 NEW PT VISIT - 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98310584 HC PR 96376 TX/PRO/DX INJ SAME DRUG ADON PROCEDURE E & M-Profees ACTIVE 0983 96376 $99.88CC WCB FAMILY MED CLINIC 98310838 HC PR G0250 INR TEST REVIEW INTER MGNT (G0250) PROCEDURE E & M-Profees ACTIVE 0983 G0250 $0.00CC WCB FAMILY MED CLINIC 98310849 HC PR 54065 DESTRUCTION PENIS LESION(S), EXTENSIVE PROCEDURE Surgical Procedure ACTIVE 0983 54065 $1,876.88CC WCB FAMILY MED CLINIC 98310855 HC PR 29581 MULTILAYER WND COMPRESSION PROCEDURE Surgical Procedure-Profee ACTIVE 0983 29581 $374.54CC WCB FAMILY MED CLINIC 98310882 HC INTENS BEHAVE THER CARDIO DX PROCEDURE Surgical Procedure ACTIVE 0943 G0446 $76.99CC WCB FAMILY MED CLINIC 98310895 HC PR G0248 DEMONSTRATE USE HOME INR MON PROCEDURE E & M ACTIVE 0983 G0248 $0.00CC WCB FAMILY MED CLINIC 98310916 HC PR G0442 ANNUAL ALCOHOL SCREEN 15 MIN PROCEDURE E & M ACTIVE 0983 G0442 $76.99CC WCB FAMILY MED CLINIC 98310917 HC PR G0443 BRIEF ALCOHOL MISUSE COUNSEL PROCEDURE E & M ACTIVE 0983 G0443 $76.99CC WCB FAMILY MED CLINIC 98310966 HC PR 1074M PROGRESS REPORT PROCEDURE E & M-Profees ACTIVE 0983 1074M $59.30CC WCB FAMILY MED CLINIC 98310969 HC PR G0444 DEPRESSION SCREEN ANNUAL PROCEDURE E & M-Profees ACTIVE 0983 G0444 $76.99CC WCB FAMILY MED CLINIC 98310987 HC PR 67800 REMOVE EYELID LESION PROCEDURE Surgical Procedure-Profee ACTIVE 0983 67800 $408.88CC WCB FAMILY MED CLINIC 98311028 HC PR 20525 REMOVAL OF FOREIGN BODY COMPLEX PROCEDURE Surgical Procedure-Profee ACTIVE 0983 20525 $1,220.39CC WCB FAMILY MED CLINIC 98311071 HC PR 90097 REOPEN L & I CLAIM PROCEDURE Professional Fees ACTIVE 0983 90097 $78.03CC WCB FAMILY MED CLINIC 98311073 HC PR 1047M CERT OF DISABILITY FORM PROCEDURE Professional Fees ACTIVE 0983 1047M $31.21CC WCB FAMILY MED CLINIC 98311074 HC PR 1067M 4TH WEEK TL COMPLEX-COHE PROCEDURE Professional Fees ACTIVE 0983 1067M $470.26CC WCB FAMILY MED CLINIC 98311075 HC PR 1067M 4TH WEEK TL BRIEF EVAL-COHE PROCEDURE Professional Fees ACTIVE 0983 1067M $586.79CC WCB FAMILY MED CLINIC 98311077 HC PR 1152M INITIAL EVAL & COORDINATION PROCEDURE Professional Fees ACTIVE 0983 1152M $176.87CC WCB FAMILY MED CLINIC 98311078 HC PR 1193M IME-CONSULT PROCEDURE Professional Fees ACTIVE 0983 1193M $447.37CC WCB FAMILY MED CLINIC 98311079 HC PR 1194M IME-CONSULT STANDARD PROCEDURE Professional Fees ACTIVE 0983 1194M $658.57CC WCB FAMILY MED CLINIC 98311080 HC PR 1195M IME-CONSULT COMPLEX PROCEDURE Professional Fees ACTIVE 0983 1195M $820.88CC WCB FAMILY MED CLINIC 98311082 HC PR 3085F SUICIDE RISK ASSESSED PROCEDURE Professional Fees ACTIVE 0983 3085F $35.70CC WCB FAMILY MED CLINIC 98311083 HC PR 2019F DILATED MACULAR EXAM PERFORMED PROCEDURE Nursing-Profees ACTIVE 0983 2019F $0.00CC WCB FAMILY MED CLINIC 98311084 HC PR 3315F ESTROGEN OR PROGESTERONE RECEPTOR POSITIVE PROCEDURE Nursing-Profees ACTIVE 0983 3315F $0.00CC WCB FAMILY MED CLINIC 98311085 HC PR 94762 NONINVASV OXYGEN SATUT,CONTINUOUS PROCEDURE Nursing-Profees ACTIVE 0983 94762 $98.84CC WCB FAMILY MED CLINIC 98311086 HC PR 2014F MENTAL STATUS ASSESSED PROCEDURE Nursing-Profees ACTIVE 0983 2014F $35.70CC WCB FAMILY MED CLINIC 98311087 HC PR 1006F OSTEOARTHRITIS ASSESS STATUS ASSESSED PROCEDURE Nursing-Profees ACTIVE 0983 1006F $0.00CC WCB FAMILY MED CLINIC 98311088 HC PR 4179F TOMOXIFEN OR AROMATASE INHIBITOR PRESCRIBEDPROCEDURE Nursing-Profees ACTIVE 0983 4179F $0.00CC WCB FAMILY MED CLINIC 98311112 HC PR 90702 VFC DT IMMUNIZATION, IM <7YO PROCEDURE Nursing-Profees ACTIVE 0636 90702 $28.09CC WCB FAMILY MED CLINIC 98311140 HC PR 98960 SELF-MGMT EDUC & TRAIN, 1 PT, EA 30 MIN PROCEDURE E & M-Profees ACTIVE 0983 98960 $137.33CC WCB FAMILY MED CLINIC 98311144 HC PR G0296 VISIT TO DETERM LDCT ELIG PROCEDURE E & M-Profees ACTIVE 0983 G0296 $172.71CC WCB FAMILY MED CLINIC 98311179 HC PR ENHANCED COMP GERIATRIC ASSMT PROCEDURE Professional Fees ACTIVE 0983 S0250CC WCB FAMILY MED CLINIC 98311227 HC PR G8754 DIAS BP LESS 90 PROCEDURE E & M-Profees ACTIVE 0983 G8754 $0.00CC WCB FAMILY MED CLINIC 98311235 HC PR G8938 BMI CALC, PT 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ACTIVE 0983 99456 $457.78CC WCB FAMILY MED CLINIC 98311324 HC PR 99456 DISABILITY EXAM/OTHER DR, EXPANDED PROCEDURE E & M-Profees ACTIVE 0983 99456 $557.65CC WCB FAMILY MED CLINIC 98311352 HC PR L1902 AFO ANKLE GAUNTLET PRE OTS PROCEDURE E & M-Profees ACTIVE 0983 L1902 $47.86CC WCB FAMILY MED CLINIC 98311369 HC PR G0420 KIDNEY DISEASE EDUCATION PER ONE HR PROCEDURE E & M-Profees ACTIVE 0983 G0420 $242.41CC WCB FAMILY MED CLINIC 98311370 HC PR G2015 PHYS CONF W/FAMILY HEALTH PROCEDURE E & M-Profees ACTIVE 0983 G2015 $229.93CC WCB FAMILY MED CLINIC 98311371 HC PR P3001 SCREENING PAP MEDICARE PROCEDURE E & M-Profees ACTIVE 0983 P3001 $312.12CC WCB FAMILY MED CLINIC 98311372 HC PR 59897 UNLISTED FETAL INVASIVE PROCEDURE PROCEDURE E & M-Profees ACTIVE 0983 59897 $276.75

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PROCEDURE LAB ACTIVE 0302 86593 $52.63CC WCB LABORATORY 30210074 HC PROTEIN ELECTROPHORESIS SERUM PROCEDURE LAB ACTIVE 0300 84165 $98.69CC WCB LABORATORY 30210102 HC F-ACTIN (SMOOTH MUSCLE) AB IGG PROCEDURE LAB ACTIVE 0300 83516 $316.81CC WCB LABORATORY 30210104 HC GAMMAGLOBULIN IGA PROCEDURE LAB ACTIVE 0300 82784 $94.92CC WCB LABORATORY 30210189 HC FLUORESCENT NONNFCT AGT ANTB TITER EA ANTIBODY # PROCEDURE LAB ACTIVE 0302 86256 $34.78CC WCB LABORATORY 30210205 HC EXTRACTABLE NUCLEAR ANTIGEN ANTIBODY ANY METHOD # PROCEDURE LAB ACTIVE 0302 86235 $123.78CC WCB LABORATORY 30210208 HC BLOOD TYPING SEROLOGIC ABO # PROCEDURE LAB ACTIVE 0302 86900 $34.83CC WCB LABORATORY 30210208 HC BLOOD TYPING SEROLOGIC ABO # PROCEDURE LAB ACTIVE 0302 86900 $5.00CC WCB LABORATORY 30210209 HC BLOOD TYPING SEROLOGIC RH (D) # PROCEDURE LAB ACTIVE 0302 86901 $34.83CC WCB LABORATORY 30210209 HC BLOOD TYPING SEROLOGIC RH (D) # PROCEDURE LAB ACTIVE 0302 86901 $5.00CC WCB LABORATORY 30210210 HC ANTIBODY HIV-2 # PROCEDURE LAB ACTIVE 0302 86702 $109.24CC WCB LABORATORY 30210211 HC ANTIBODY FUNGUS NOT ELSEWHERE SPECIFIED # 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63610555 HC PR S0164 INJECTION, PANTOPRAZOLE SODIUM, 40 MG PROCEDURE Medications ACTIVE 0636 S0164 $186.2376110004 HC NEW PT VISIT - LEVEL 4 PROCEDURE E & M ACTIVE 0761 99204 $77.0076110004 HC NEW PT VISIT - LEVEL 4 PROCEDURE E & M ACTIVE 0761 99204 $308.5076110004 HC NEW PT VISIT - LEVEL 4 PROCEDURE E & M ACTIVE 0761 99204 $385.5076110004 HC NEW PT VISIT - LEVEL 4 PROCEDURE E & M ACTIVE 0761 99204 $0.0076110004 HC NEW PT VISIT - LEVEL 4 PROCEDURE E & M ACTIVE 0761 99204 $385.5076110004 HC NEW PT VISIT - LEVEL 4 PROCEDURE E & M ACTIVE 0761 99204 $385.5096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $21.0096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $26.0096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $5.0096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $26.0096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $0.0096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $26.0096010002 HC PR 99499 EXAM, SPORTS PHYSICAL PROCEDURE E & M-Profees ACTIVE 0960 99499 $63.4496100000 HC PR 99494 1ST/SBSQ PSYC COLLAB CARE ADD ON PROCEDURE Professional Fees ACTIVE 0961 99494 $280.5096110088 HC PR 99484 CARE MGMT SVC BHVL HLTH COND PROCEDURE E & M-Profees ACTIVE 0961 99484 $182.0796110089 HC PR 99492 1ST PSYC COLLAB CARE MGMT PROCEDURE E & M-Profees ACTIVE 0961 99492 $357.0096110090 HC PR 99493 SBSQ PSYC COLLAB CARE MGMT PROCEDURE E & M-Profees ACTIVE 0961 99493 $331.5096910042 HC PR J1100 DEXAMETHASONE 1MG PROCEDURE Medications ACTIVE 0983 J1100 $9.3696910114 HC PR 99334 DOMICIL/R-HOME VISIT EST PAT LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99334 $130.0596910117 HC PR 99341 HOME VISIT NEW PATIENT LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99341 $168.5496910118 HC PR 99342 HOME VISIT NEW PATIENT LEVEL 2 PROCEDURE E & M-Profees ACTIVE 0983 99342 $209.1296910119 HC PR 99343 HOME VISIT NEW PATIENT LEVEL 3 PROCEDURE E & M-Profees ACTIVE 0983 99343 $271.5496910120 HC PR 99344 HOME VISIT NEW PATIENT LEVEL 4 PROCEDURE E & M-Profees ACTIVE 0983 99344 $384.9596910121 HC PR 99345 HOME VISIT NEW PATIENT LEVEL 5 PROCEDURE E & M-Profees ACTIVE 0983 99345 $520.2096910122 HC PR 99347 HOME VISIT EST PATIENT LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0983 99347 $130.0596910124 HC PR 99349 HOME VISIT EST PATIENT LEVEL 3 PROCEDURE E & M-Profees ACTIVE 0983 99349 $242.4196910125 HC PR 99350 HOME VISIT EST PATIENT LEVEL 4 PROCEDURE E & M-Profees ACTIVE 0983 99350 $387.0396910142 HC PR 99380 NURSING FAC CARE SUPERVISION > 30 MIN PROCEDURE E & M-Profees ACTIVE 0983 99380 $215.3696910154 HC PR 99385 PREV VISIT NEW AGE 18-39 PROCEDURE E & M-Profees ACTIVE 0983 99385 $374.5496910156 HC PR 99386 PREV VISIT NEW AGE 40-64 PROCEDURE E & M-Profees ACTIVE 0983 99386 $409.9296910158 HC PR 99387 INIT PM E/M NEW PAT 65+ YRS PROCEDURE E & M-Profees ACTIVE 0983 99387 $461.9496910170 HC PR 99395 PREV VISIT EST AGE 18-39 PROCEDURE E & M-Profees ACTIVE 0983 99395 $312.1296910172 HC PR 99396 PREV VISIT EST AGE 40-64 PROCEDURE E & M-Profees ACTIVE 0983 99396 $340.2196910174 HC PR 99397 PER PM REEVAL EST PAT 65+ YR PROCEDURE LAB-Profees ACTIVE 0983 99397 $387.0396910178 HC PR 99402 PREVENTIVE COUNSELING INDIV 30 MIN PROCEDURE E & M-Profees ACTIVE 0983 99402 $201.8496910180 HC PR 99403 PREVENTIVE COUNSELING INDIV 45 MIN PROCEDURE E & M-Profees ACTIVE 0983 99403 $302.7696910182 HC PR 99404 PREVENTIVE COUNSELING INDIV 60 MIN PROCEDURE E & M-Profees ACTIVE 0983 99404 $403.6896910188 HC PR 99442 PHONE E/M BY PHYS 11-20 MIN PROCEDURE E & M-Profees ACTIVE 0983 99442 $91.5696910190 HC PR 99443 PHONE E/M BY PHYS 21-30 MIN PROCEDURE E & M-Profees ACTIVE 0983 99443 $183.1196910191 HC PR 99455 WORK RELATED DISABILITY EXAM PROCEDURE E & M-Profees ACTIVE 0983 99455 $171.6796910299 HC PR 54056 CRYOSURGERY PENIS LESION(S) PROCEDURE Surgical Procedure-Profee ACTIVE 0983 54056 $434.8996910316 HC PR G0402 INITIAL PREVENTIVE EXAM MC PROCEDURE E & M-Profees ACTIVE 0983 G0402 $406.8096910370 HC PR 99328 NP AST LVG/FSTER CRE V PROCEDURE E & M-Profees ACTIVE 0983 99328 $528.5296910371 HC PR 99337 DOMICIL/R-HOME VISIT EST PAT LEVEL 4 PROCEDURE E & M-Profees ACTIVE 0983 99337 $388.0796910436 HC PR G0101 SCREEN;PELVIC/BREAST EXAM PROCEDURE E & M-Profees ACTIVE 0983 G0101 $312.1296910437 HC PR G0102 PROSTATE CA SCREENING; 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96910870 HC PR 29355 APPLICATION OF LONG LEG CAST PROCEDURE Surgical Procedure-Profee ACTIVE 0983 29355 $510.0096910919 HC PR 90733 MENINGOCOCCAL VACCINE SUBCUTANEOUS PROCEDURE Nursing-Profees ACTIVE 0636 90733 $215.3696910933 HC PR 99446 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 PROCEDURE E & M-Profees ACTIVE 0983 99446 $52.0296910934 HC PR 99447 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-2 PROCEDURE E & M-Profees ACTIVE 0983 99447 $102.0096910935 HC PR 99448 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-3 PROCEDURE E & M-Profees ACTIVE 0983 99448 $153.0096910936 HC PR 99449 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> PROCEDURE E & M-Profees ACTIVE 0983 99449 $204.0096911127 HC PR 99497 ADVNCD CARE PLAN 30 MIN PROCEDURE E & M-Profees ACTIVE 0983 99497 $141.4996911540 HC PR 99455 CDL/FLIGHT PHYSICAL ONLY - NO EKG PROCEDURE E & M-Profees ACTIVE 0969 99445 $148.7796911541 HC PR 99455 FLIGHT PHYSICAL W/EKG PROCEDURE E & M-Profees ACTIVE 0969 99445 $197.6896911542 HC PR 99455 CDL FOLLOW UP VISIT PROCEDURE E & M-Profees ACTIVE 0969 99445 $43.7097210029 HC PR 76942 ECHO GUIDE FOR BIOPSY NEEDLE PLACEMENT PROCEDURE IMAGING-Profees ACTIVE 0972 76942 $195.6097510072 HC PR 11057 TRIM SKIN LESIONS OVER 4 PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11057 $170.6397510092 HC PR 11646 EXC FACE-MM MLG+MARG > 4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11646 $1,670.8897510458 HC PR 11606 EXC TR-EXT MLG+MARG > 4 CM PROCEDURE Surgical Procedure-Profee ACTIVE 0975 11606 $1,253.6897510476 HC PR G0182 HOSPICE CARE SUPERVISION PROCEDURE Surgical Procedure-Profee ACTIVE 0975 G0182 $0.0097510761 HC PR 45333 SIGMOIDOSCOPY & POLYPECTOMY PROCEDURE Surgical Procedure-Profee ACTIVE 0975 45333 $1,449.2897511651 HC PR 15832 EXCISE EXCESSIVE SKIN THIGH PROCEDURE Surgical Procedure ACTIVE 0975 15832 $2,555.2297511655 HC PR 15837 EXCISE EXCESS SKIN ARM/HAND PROCEDURE Surgical Procedure ACTIVE 0975 15837 $2,117.2198110926 HC PR J1050 MEDROGESTERONE 1 MG INJ PROCEDURE ER MAIN-Profees ACTIVE 0636 J1050 $2.0898210093 HC PR 1027M L&I LOSS EARNING PWR FORM PROCEDURE E & M-Profees ACTIVE 0982 1027M $73.8798210100 HC PR 1064M L&I INITIAL REPORT FOR DOC. OPIOD TRMNT PROCEDURE E & M-Profees ACTIVE 0982 1064M $68.6798210117 HC PR 1191M L&I IMPAIRMENT RATING BY AP PER INSURER REQ PROCEDURE E & M-Profees ACTIVE 0982 1191M $658.5798210118 HC PR 1192M L&I IMPAIRMENT RATING BY AP PER INSURER REQ PROCEDURE E & M-Profees ACTIVE 0982 1192M $820.8898210122 HC PR G0247 ROUTINE FOOTCARE PT W LOPS PROCEDURE Surgical Procedure-Profee ACTIVE 0982 G0247 $0.0098210132 HC PR 93978 VASCULAR STUDY AORTA/IVC/ILIAC COMPLETE PROCEDURE IMAGING ACTIVE 0982 93978 $195.8498310030 HC PR G0438 PPPS, INITIAL VISIT PROCEDURE E & M-Profees ACTIVE 0983 G0438 $406.8098310031 HC PR G0439 PPPS, SUBSEQ VISIT PROCEDURE E & M-Profees ACTIVE 0983 G0439 $387.0398310385 HC PR 82947 ASSAY GLUCOSE BLOOD QUANT PROCEDURE LAB-Profees ACTIVE 0983 82947 $29.8998310387 HC PR 85014 HEMATOCRIT PROCEDURE LAB-Profees ACTIVE 0983 85014 $23.4198310521 HC PR G0181 HOME HEALTH CARE SUPERVISION PROCEDURE E & M-Profees ACTIVE 0983 G0181 $0.0098810001 HC PR 99241 OFFICE CONSULTATION LEVEL 1 PROCEDURE E & M-Profees ACTIVE 0988 99241 $225.7898810004 HC PR 99244 OFFICE CONSULTATION LEVEL 4 PROCEDURE E & M-Profees ACTIVE 0988 99244 $478.5898810023 HC PR 99451 NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5/> PROCEDURE E & M-Profees ACTIVE 0988 99451 $52.0298810024 HC PR 99452 NTRPROF PHONE/NTRNET/EHR REFERRAL SVC 30 M PROCEDURE E & M-Profees ACTIVE 0988 99452 $153.0099010288 HC BLOOD DRAW IMPLANTED VAD (STAT ONLY) PROCEDURE STATS ONLY ACTIVE 0990 36591 $0.0099010498 HC PR 99238 HOSPITAL DISCHARGE DAY < 30 MINUTES (STAT ONLPROCEDURE E & M-Profees ACTIVE 0990 99238 $0.0099012353 HC SUTURE REMOVAL (STAT ONLY) PROCEDURE STATS ONLY ACTIVE 0990 99012353 $0.0099012584 HC WOUND DRESS/DEBRIDE-SM (STAT ONLY) PROCEDURE STATS ONLY ACTIVE 0990 16020 $0.0099013469 HC PR 4040F PNEUMOCOCCAL IMMUNIZATION ORDERED/ADMINPROCEDURE STATS ONLY ACTIVE 0990 4040F $0.0099013529 HC PR 1111F DSCHRG MED/CURRENT MED MERGE PROCEDURE STATS ONLY ACTIVE 0990 1111F $0.0099015054 HC PR G8417 CALC BMI ABV PARAM PROCEDURE E & M ACTIVE 0990 G8417 $0.00