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  1. ITEMCHARGE CPT4 EFF_DATE CPT4MOD
  2. 326.8 29075 20101204 GO
  3. 326.8 29075 20110104 GO
  4. 326.8 29075 20110204 GO
  5. 326.8 29075 20110406 GO
  6. 352.69 29075 20090611 GO
  7. 352.69 29075 20090917 GO
  8. 352.69 29075 20100614 GO
  9. 352.69 29075 20100722 GO
  10.  
  11. ITEMCHARGE CPT4 EFF_DATE CPT4MOD
  12. 326.8 29075 20110406 GO
  13. 352.69 29075 20100722 GO
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