L5645 Durable Medical Equipment Prosthetic Devices BK FLEX INNER SOCKET EXT FRA BK FLEX INNER SOCKET EXT FRA
L5647 Durable Medical Equipment Prosthetic Devices BELOW KNEE SUCTION SOCKET BELOW KNEE SUCTION SOCKET
L5649 Durable Medical Equipment Prosthetic Devices ISCH CONTAINMT/NARROW M-L SO ISCH CONTAINMT/NARROW M-L SO
L5650 Durable Medical Equipment Prosthetic Devices TOT CONTACT AK/KNEE DISART S TOT CONTACT AK/KNEE DISART S
P9603 Inpatient Medical and Surgical Care in a General Hospital Labs, X-Rays and Other Tests ONE-WAY ALLOW PRORATED MILES ONE-WAY ALLOW PRORATED MILES
Q0081 Emergency Medical Outpatient Services Home Health Care Maternity Services Medical Care Outpatient Visits Radiation Therapy and Chemotherapy INFUSION THER OTHER THAN CHE INFUSION THER OTHER THAN CHE